1831324219 NPI number — DR. CHRISTOPHER THOMAS REYNOLDS DMD

Table of content: DR. CHRISTOPHER THOMAS REYNOLDS DMD (NPI 1831324219)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831324219 NPI number — DR. CHRISTOPHER THOMAS REYNOLDS DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REYNOLDS
Provider First Name:
CHRISTOPHER
Provider Middle Name:
THOMAS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831324219
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12 ARLEY WAY # B
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
BLUFFTON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29910-8859
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-757-3060
Provider Business Mailing Address Fax Number:
843-757-3061

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12 ARLEY WAY # B
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
BLUFFTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29910-8859
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-757-3060
Provider Business Practice Location Address Fax Number:
843-757-3061
Provider Enumeration Date:
05/28/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  4531 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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