Individual
JEFFREY REYNOLDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
14243 HWY 90, BOUTTE, LA 70394
(985) 785-0488
Mailing address
14243 HWY 90, BOUTTE, LA 70394
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6076
LA
Other
Enumeration date
07/15/2010
Last updated
07/15/2010
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