Provider Demographics
NPI:1336266782
Name:REYNOLDS, ROBERT CHRISTOPHER (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CHRISTOPHER
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 CANDLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-1623
Mailing Address - Country:US
Mailing Address - Phone:401-885-3624
Mailing Address - Fax:
Practice Address - Street 1:1071 MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02893-3715
Practice Address - Country:US
Practice Address - Phone:401-821-9209
Practice Address - Fax:401-821-9209
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN021951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIRR01261Medicaid