Provider Demographics
NPI:1730318924
Name:REYNOLDS, KYLE W (DMD)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:W
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7901 MALL RD STE 200
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-1496
Mailing Address - Country:US
Mailing Address - Phone:859-647-7600
Mailing Address - Fax:859-647-0213
Practice Address - Street 1:7901 MALL RD STE 200
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1496
Practice Address - Country:US
Practice Address - Phone:859-647-7600
Practice Address - Fax:859-647-0213
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY88001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice