Provider Demographics
NPI:1942748140
Name:REYNOLDS, ALISHA DIANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALISHA
Middle Name:DIANE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9199 REISTERSTOWN RD STE 203A
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4514
Mailing Address - Country:US
Mailing Address - Phone:410-356-8571
Mailing Address - Fax:410-356-8574
Practice Address - Street 1:9199 REISTERSTOWN RD STE 203A
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117
Practice Address - Country:US
Practice Address - Phone:410-356-8571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-08
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16215122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD800126350Medicaid