Individual provider Active NPI

Stefanie Ann Reynolds, D.M.D.

  • Dentist
  • Vista, CA
National Provider Identifier
1366775793
Registry record updated Dec 12, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
58572 Issued in CA
Practice address
1000 Vale Terrace Dr
Vista, CA 92084-5218
Phone
(760) 407-1220
Fax
(760) 414-3702
NPI assigned
Sep 17, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 58572 CA Primary
Public Health Dentistry 1223D0001X 58572 CA
General Practice Dentistry 1223G0001X 58572 CA
Pediatric Dentistry 1223P0221X 58572 CA
Periodontics 1223P0300X 58572 CA

Addresses

Primary practice location

1000 Vale Terrace Dr
Vista, CA 92084-5218

Mailing address

1000 Vale Terrace Dr
Vista, CA 92084-5218
Phone (760) 407-1220

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120430000721 CA Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 7517129067

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
58572CAMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1253145600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323648000000",
    "number": "1366775793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 VALE TERRACE DR",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920845218",
            "telephone_number": "760-407-1220",
            "fax_number": "760-414-3702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 VALE TERRACE DR",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920845218",
            "telephone_number": "760-407-1220",
            "fax_number": "760-414-3702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "STEFANIE",
        "middle_name": "ANN",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-17",
        "last_updated": "2011-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "58572",
            "primary": true
        },
        {
            "code": "1223D0001X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Public Health",
            "state": "CA",
            "license": "58572",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "58572",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "58572",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "58572",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vista, CA

Sources for this page

Verify at the official NPI Registry.