Provider Demographics
NPI:1396482725
Name:REYNOLDS, DANIELLE RENE (RDH)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:RENE
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 1:16827 BUFFALO VALLEY PATH
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-7172
Mailing Address - Country:US
Mailing Address - Phone:484-300-1406
Mailing Address - Fax:
Practice Address - Street 1:11577 W 38TH PL
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-3803
Practice Address - Country:US
Practice Address - Phone:303-422-3175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-17
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH002023724124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty