Provider Demographics
NPI:1841842598
Name:MICHAEL LIAM REYNOLDS, DDS, LLC
Entity type:Organization
Organization Name:MICHAEL LIAM REYNOLDS, DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:HELEN
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:503-702-1370
Mailing Address - Street 1:1350 IOWA ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2224
Mailing Address - Country:US
Mailing Address - Phone:415-672-5557
Mailing Address - Fax:
Practice Address - Street 1:984 NE 8TH STREET
Practice Address - Street 2:GRANTS PASS OREGON
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526
Practice Address - Country:US
Practice Address - Phone:541-471-7062
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty