Active NPI
William Albert Reynolds III, DDS
- Dentist
- Cross Lanes, WV
National Provider Identifier
1306910104
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 3538
- Practice address
- 5304 Koontz Dr
Cross Lanes, WV 25313 - Phone
- (304) 776-1821
- Fax
- (304) 776-3020
- NPI assigned
- Nov 20, 2006
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 3538 | WV | Primary |
Addresses
Primary practice location
5304 Koontz Dr
Cross Lanes, WV 25313
Mailing address
5304 Koontz Dr
Cross Lanes, WV 25313
Phone (304) 776-1821
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WV
- 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 |
|---|---|---|---|---|
| I20150831002864 | WV | Order and Referring Only - Oral Surgery | 8224344643 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163980800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1306910104",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5304 KOONTZ DR",
"city": "CROSS LANES",
"state": "WV",
"postal_code": "25313",
"telephone_number": "304-776-1821",
"fax_number": "304-776-3020"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5304 KOONTZ DR",
"city": "CROSS LANES",
"state": "WV",
"postal_code": "25313",
"telephone_number": "304-776-1821",
"fax_number": "304-776-3020"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REYNOLDS",
"first_name": "WILLIAM",
"middle_name": "ALBERT",
"name_prefix": "Dr.",
"name_suffix": "III",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WV",
"license": "3538",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cross Lanes, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.