| Jack J. Reynolds Jr. D.d.s., Llc | |
|
1002 Oak Dr Richmond IN 47374-1916 | |
| (765) 966-7602 | |
| (765) 962-1066 |
| Full Name | Jack J. Reynolds Jr. D.d.s., Llc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 1002 Oak Dr, Richmond, Indiana |
| Authorized Official Name and Position | Jack J. Reynolds (OWNER) |
| Authorized Official Contact | 7659667602 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jack J. Reynolds Jr. D.d.s., Llc 1002 Oak Dr Richmond IN 47374-1916 Ph: (765) 966-7602 | Jack J. Reynolds Jr. D.d.s., Llc 1002 Oak Dr Richmond IN 47374-1916 Ph: (765) 966-7602 |
| NPI Number | 1932569415 |
|---|---|
| Provider Enumeration Date | 02/26/2016 |
| Last Update Date | 02/26/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932569415 | NPI | - | NPPES |
| 100255900 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 12007171A (Indiana) | Primary |
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