Provider Demographics
NPI:1700960077
Name:REASNER, JERRY W (DMD)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:W
Last Name:REASNER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 MONTCLAIR ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35213
Mailing Address - Country:US
Mailing Address - Phone:205-595-2626
Mailing Address - Fax:205-592-9241
Practice Address - Street 1:924 MONTCLAIR ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35213
Practice Address - Country:US
Practice Address - Phone:205-595-2626
Practice Address - Fax:205-592-9241
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL40091223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics