Provider Demographics
NPI:1811248065
Name:REYNAUD, DAVID ANTHONY (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ANTHONY
Last Name:REYNAUD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:THEODORE
Other - Middle Name:
Other - Last Name:HAINES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:810 AVENUE D
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-2385
Mailing Address - Country:US
Mailing Address - Phone:360-568-8577
Mailing Address - Fax:
Practice Address - Street 1:810 AVENUE D
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-2385
Practice Address - Country:US
Practice Address - Phone:360-568-8577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA4886122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist