Reynolds Oral & Maxillofacial Surgery, INC
Oral & Maxillofacial Surgery in Princeton, WV. Organization (NPI-2).
NPI number1831784883
StatusActive
Last updated in NPPESFeb 11, 2022
Details
- NPI
- 1831784883
- Entity type
- Organization (NPI-2)
- Legal business name
- Reynolds Oral & Maxillofacial Surgery, INC
- Organization subpart
- No
- Enumeration date
- Mar 2, 2021
- Certification date
- Dec 27, 2021
- Last updated
- Feb 11, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 204E00000X | Oral & Maxillofacial Surgery | – | – | Yes |
| 261QS0112X | Clinic/Center, Oral and Maxillofacial Surgery | – | – |
Practice location
104 Vine StPrinceton, WV 24740-3931
Phone 304-250-1214 · Fax 681-282-5792
Mailing address
104 Vine StPrinceton, WV 24740-3931
Authorized official
Kristopher Reynolds
Owner
3042501214
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