Provider Demographics
NPI:1952374274
Name:REYNOLDS, MARIS JOSEPHINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIS
Middle Name:JOSEPHINE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2260 FM 1092
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-1802
Mailing Address - Country:US
Mailing Address - Phone:281-499-8340
Mailing Address - Fax:281-499-7496
Practice Address - Street 1:2260 FM 1092
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-1802
Practice Address - Country:US
Practice Address - Phone:281-499-8340
Practice Address - Fax:281-499-7496
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114491223G0001X
TX17992183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Not Answered183500000XPharmacy Service ProvidersPharmacist