Active NPI
Mark A. Reynolds, D.D.S., PH.D.
- Periodontics
- Towson, MD
National Provider Identifier
1295979938
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 9154
- Practice address
- 660 Kenilworth Dr
Suite 103
Towson, MD 21204-2313 - Phone
- (410) 821-8800
- NPI assigned
- Apr 24, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 9154 | MD | Primary |
Addresses
Primary practice location
660 Kenilworth Dr
Suite 103
Towson, MD 21204-2313
Mailing address
650 W Baltimore St
Umb Dental School
Baltimore, MD 21201-1510
Phone (410) 706-7153
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MD
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151221002261 | MD | Order and Referring Only - Dentist | 7214079292 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9154 | MD | MD | Periodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Feldman, Sachs & Fitzgerald, DDS, PA | Periodontics | Past | Accepting new patients |
Interoperability endpoints
- mreynolds7087@direct.umm.edu
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1240531200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1240531200000",
"number": "1295979938",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "650 W BALTIMORE ST",
"address_2": "UMB DENTAL SCHOOL",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212011510",
"telephone_number": "410-706-7153"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "660 KENILWORTH DR",
"address_2": "SUITE 103",
"city": "TOWSON",
"state": "MD",
"postal_code": "212042313",
"telephone_number": "410-821-8800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REYNOLDS",
"first_name": "MARK",
"middle_name": "A.",
"name_prefix": "Dr.",
"credential": "D.D.S., PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-04-24",
"last_updated": "2009-04-24",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "MD",
"license": "9154",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Towson, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.