Individual
MICHAEL REYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2952 LAZY CREEK DR, MEDFORD, OR 97504-8182
(888) 468-0022
(541) 504-3907
Mailing address
PO BOX 490, REDMOND, OR 97756-0092
(888) 468-0022
(541) 504-3907
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D9172
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
246610
—
OR
Enumeration date
09/15/2008
Last updated
10/03/2011
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