# REYNOLDS ORAL & MAXILLOFACIAL SURGERY, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831784883
- **Authorized official:** KRISTOPHER REYNOLDS (OWNER)
- **Authorized official phone:** (304) 250-1214

## Contact information

- **Practice address:** 104 VINE ST, PRINCETON, WV 24740-3931
- **Practice address phone:** (304) 250-1214
- **Practice address fax:** (681) 282-5792
- **Mailing address:** 104 VINE ST, PRINCETON, WV 24740-3931

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | NULL | Yes |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | — | Yes |
| 261QS0112X | Oral and Maxillofacial Surgery Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 03/02/2021
- **Last updated:** 02/11/2022