# JACK K. REYNOLDS DDS PA

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

## Provider details

- **NPI number:** 1841455615
- **Authorized official:** DR. SHARON ELAINE REYNOLDS LUNDGREN (D.D.S)
- **Authorized official phone:** (410) 676-5252

## Contact information

- **Practice address:** 2104 TRIMBLE RD, EDGEWOOD, MD 21040-3126
- **Practice address phone:** (410) 676-5252
- **Practice address fax:** (410) 679-4068
- **Mailing address:** PO BOX 696, EDGEWOOD, MD 21040-0696
- **Mailing address phone:** (410) 676-5252
- **Mailing address fax:** (410) 679-4068

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | Yes |
| 122300000X | Dentist | — | — | Yes |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | NULL | — |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | — | — |

## Other

- **Enumeration date:** 07/22/2008
- **Last updated:** 07/22/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 817292 | UNITED CONCORDIA | MD |