Individual
LEVI REYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2921 5TH AVE NE STE 110, PUYALLUP, WA 98372-7044
(253) 592-3687
Mailing address
2921 5TH AVE NE STE 110, PUYALLUP, WA 98372-7044
(253) 841-3173
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DE60865459
WA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/12/2017
Last updated
07/26/2022
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