Individual
DR. JACK THOMAS REYNOLDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
4100 NE VIVION RD, KANSAS CITY, MO 64119-2811
(816) 454-6443
(816) 454-3145
Mailing address
4100 NE VIVION RD, KANSAS CITY, MO 64119-2811
(816) 454-6443
(816) 454-3145
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2016016886
MO
Other
Enumeration date
06/22/2016
Last updated
06/22/2016
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