Provider Demographics
NPI:1932216595
Name:REYNOLDS, DAVID NEPHI (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:NEPHI
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:846 E MEADOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:UT
Mailing Address - Zip Code:84004-1756
Mailing Address - Country:US
Mailing Address - Phone:801-888-8923
Mailing Address - Fax:
Practice Address - Street 1:11576 S STATE ST STE 1201
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-7117
Practice Address - Country:US
Practice Address - Phone:801-716-7006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10270092-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice