Organization
JACK J. REYNOLDS JR. D.D.S., LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK J. REYNOLDS JR. D.D.S. (OWNER)
(765) 966-7602
Entity
Organization
Contact information
Practice address
1002 OAK DR, RICHMOND, IN 47374-1916
(765) 966-7602
(765) 962-1066
Mailing address
1002 OAK DR, RICHMOND, IN 47374-1916
(765) 966-7602
(765) 962-1066
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
12007171A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100255900
—
IN
Enumeration date
02/26/2016
Last updated
02/26/2016
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