Organization
JACK K. REYNOLDS DDS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHARON ELAINE REYNOLDS LUNDGREN (D.D.S)
(410) 676-5252
Entity
Organization
Contact information
Practice address
2104 TRIMBLE RD, EDGEWOOD, MD 21040-3126
(410) 676-5252
(410) 679-4068
Mailing address
PO BOX 696, EDGEWOOD, MD 21040-0696
(410) 676-5252
(410) 679-4068
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
817292
UNITED CONCORDIA
MD
Enumeration date
07/22/2008
Last updated
07/22/2008
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