Provider Demographics
NPI:1356749485
Name:REYNOLDS, TRACI-ANN SEANA (RDH)
Entity type:Individual
Prefix:MS
First Name:TRACI-ANN
Middle Name:SEANA
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 225
Mailing Address - Street 2:
Mailing Address - City:MASONVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80541
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1135 N. LINCOLN AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537
Practice Address - Country:US
Practice Address - Phone:970-622-0970
Practice Address - Fax:970-622-0971
Is Sole Proprietor?:No
Enumeration Date:2014-12-05
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH000201948124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist