Individual
DR. GLENDA CHARLENE REYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
56720 CALUMET AVE, CALUMET, MI 49913-1967
(906) 483-1177
(906) 483-1188
Mailing address
894 CAMPUS DR, SUITE B, HANCOCK, MI 49930-1644
(906) 483-1445
(906) 483-1122
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2637
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000304310 A
EMPLOYEE BENEFIT ID #
NH
01
—
000800643
APWU PROVIDER ID
NH
01
—
000891547
UNITED CONCORDIA PROVIDER
NH
01
—
US00XXXXX00000010000
DELTA PROVIDER ID
NH
Enumeration date
06/05/2007
Last updated
02/20/2017
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