Dr. Kenneth Bradley Reynolds, D.D.S
Dentist in Portsmouth, VA. Individual provider (NPI-1).
NPI number1003974080
StatusActive
Last updated in NPPESJul 8, 2007
Details
- NPI
- 1003974080
- Entity type
- Individual (NPI-1)
- Name
- Dr. Kenneth Bradley Reynolds
- Credential
- D.D.S
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Dec 4, 2006
- Last updated
- Jul 8, 2007
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | VA6170 | VA | Yes |
Practice location
1307 Airline BlvdPortsmouth, VA 23707-4011
Phone 757-399-4662
Mailing address
788 Los Colonis DrVirginia Beach, VA 23456-6411
Phone 757-477-5051
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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