Organization
REYNOLDS ORAL & MAXILLOFACIAL SURGERY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTOPHER REYNOLDS (OWNER)
(304) 250-1214
Entity
Organization
Contact information
Practice address
104 VINE ST, PRINCETON, WV 24740-3931
(304) 250-1214
(681) 282-5792
Mailing address
104 VINE ST, PRINCETON, WV 24740-3931
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
—
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
—
—
Other
Enumeration date
03/02/2021
Last updated
02/11/2022
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