Provider Demographics
NPI:1811139439
Name:REYNARD, DAVID DEAN
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:DEAN
Last Name:REYNARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:D
Other - Last Name:REYNARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, PA
Mailing Address - Street 1:3333 NORTH STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-5032
Mailing Address - Country:US
Mailing Address - Phone:409-832-2200
Mailing Address - Fax:409-832-3659
Practice Address - Street 1:3333 NORTH STREET
Practice Address - Street 2:SUITE C
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-5032
Practice Address - Country:US
Practice Address - Phone:409-832-2200
Practice Address - Fax:409-832-3659
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78641223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics