Randy K Reynolds, D.M.D

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2053-83 Issued in MS

Practice address

208 West 3Rd Street
Forest, MS 39074

Phone

(601) 469-4881

Fax

(601) 469-3436

NPI assigned

Apr 24, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Herbison Dental LLC

  dba Herbison and Reynolds Dental Clinic

  • General Practice Dentistry
  • Forest, MS
  • NPI 1780575639
  NPD (past)
• Reynolds Dental Practice

  • General Practice Dentistry
  • Forest, MS
  • NPI 1649435116
  NPD (past)

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

{
    "created_epoch": "1177372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1770702144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 WEST 3RD STREET",
            "city": "FOREST",
            "state": "MS",
            "postal_code": "39074",
            "telephone_number": "601-469-4881",
            "fax_number": "601-469-3436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 WEST 3RD STREET",
            "city": "FOREST",
            "state": "MS",
            "postal_code": "39074",
            "telephone_number": "601-469-4881",
            "fax_number": "601-469-3436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "RANDY",
        "middle_name": "K",
        "credential": "D.M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "2053-83",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00060031",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Candace Smith Raybon, OT
• Region Ten Commission on Mental Health (Weems Mental Health)
• Ethan Reiss
• Reynolds Dental Practice
• Kevin M Reynolds, D.M.D
• Slater Henry Richardson, DPT
• Van-VI Le Richardson, MD
• Roylaty Healthcare
• Scott County Schools
• Scott Regional Medical Center, Inc. (Ochsner Health Center- Forest)

• General Practice Dentistry in Forest, MS
• Providers in Forest, MS by specialty
• General Practice Dentistry in Mississippi

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.