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Organization

REYNOLDS DENTAL PRACTICE

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. RANDALL KERMIT REYNOLDS D.M.D. (DOCTOR/OWNER)
(601) 469-4881
Entity
Organization

Contact information

Practice address
208 W THIRD ST, FOREST, MS 39074-4106
(601) 469-4881
(601) 469-3436
Mailing address
208 W THIRD ST, FOREST, MS 39074-4106
(601) 469-4881
(601) 469-3436

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary

Other

Enumeration date
07/24/2008
Last updated
10/06/2010
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