Provider Demographics
NPI:1902234727
Name:RANDALL J REYNOLDS DDS, PC
Entity Type:Organization
Organization Name:RANDALL J REYNOLDS DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:J
Authorized Official - Last Name:O'DEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-232-2214
Mailing Address - Street 1:2200 BOX ELDER ST
Mailing Address - Street 2:SUITE 121
Mailing Address - City:MILES CITY
Mailing Address - State:MT
Mailing Address - Zip Code:59301-2899
Mailing Address - Country:US
Mailing Address - Phone:406-232-2214
Mailing Address - Fax:
Practice Address - Street 1:2200 BOX ELDER ST
Practice Address - Street 2:SUITE 121
Practice Address - City:MILES CITY
Practice Address - State:MT
Practice Address - Zip Code:59301-2899
Practice Address - Country:US
Practice Address - Phone:406-232-2214
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-15
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty