Edward Reynolds Jr., DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

4544 Issued in CT

Practice address

47 Town St
Norwich, CT 06360-2315

Phone

(860) 892-7042

Fax

(860) 823-3060

NPI assigned

Aug 4, 2006

Sex

Male

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 16, 2013.

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1379289600000",
    "number": "1528076593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "47 TOWN ST",
            "address_2": "NORWICH",
            "city": "NORWICH",
            "state": "CT",
            "postal_code": "063602315",
            "telephone_number": "860-892-7042",
            "fax_number": "860-823-3060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "47 TOWN ST",
            "city": "NORWICH",
            "state": "CT",
            "postal_code": "063602315",
            "telephone_number": "860-892-7042",
            "fax_number": "860-823-3060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "EDWARD",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-04",
        "last_updated": "2013-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CT",
            "license": "4544",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "04544",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008032342",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Holly M. Renstrom
• Adam J Resnick, MD
• Cierra Reyes, LMT
• Destiny Reyes
• Joselina Reyes
• Theresa Reynolds
• Sky Rhymer
• Carla S Ricci
• Richard J Lavoie
• Rebecca L Richard, PA

• All providers in Norwich, CT
• Oral and Maxillofacial Surgery (Dentist) in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.