Individual
THOMAS JEFFERSON REYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1202 MARTIN LUTHER KING JR WAY, TACOMA, WA 98405-3926
(253) 441-4743
(253) 442-8840
Mailing address
1019 PACIFIC AVE STE 300, ATTN: CREDENTIALING, TACOMA, WA 98402-4488
(253) 597-4550
(253) 597-4556
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
30022014
OH
122300000X
Dentist
Primary
DE60192688
WA
122300000X
Dentist
DN00000
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
076805700
—
FL
05
—
252130
—
OH
Enumeration date
02/15/2006
Last updated
11/12/2015
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