Individual
DR. KENNETH BRADLEY REYNOLDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
1307 AIRLINE BLVD, PORTSMOUTH, VA 23707-4011
(757) 399-4662
Mailing address
788 LOS COLONIS DR, VIRGINIA BEACH, VA 23456-6411
(757) 477-5051
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
VA6170
VA
Other
Enumeration date
12/04/2006
Last updated
07/08/2007
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