Levi Reynolds, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE60865459 Issued in WA

Practice address

2921 5TH Ave NE Ste 110
Puyallup, WA 98372-7044

Phone

(253) 592-3687

NPI assigned

May 12, 2017

Last updated

Jul 26, 2022By 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 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 1, 2022 through Jan 1, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Levi Reynolds DDS PLLC

  dba Puyallup Valley Dental Care

  • Dental Clinic/Center
  • Puyallup, WA
  • NPI 1013675271
  NPD Authorized official
• Steven J Urback DDS Magd PS

  dba Puyallup Valley Dental Care

  • General Practice Dentistry
  • Puyallup, WA
  • NPI 1114045804
  NPD (past)

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

{
    "created_epoch": "1494547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658793600000",
    "number": "1790212470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2921 5TH AVE NE STE 110",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983727044",
            "telephone_number": "253-841-3173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2921 5TH AVE NE STE 110",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983727044",
            "telephone_number": "253-592-3687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "LEVI",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-05-12",
        "last_updated": "2022-07-26",
        "certification_date": "2022-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE60865459",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lise S. Retailliau, D.O.
• Reilly Elizabeth Retz, DPT
• Revera (Delaware) LLC (Linden Grove Health Care Center)
• Revitalize and Restore Therapy (Rachael Jordan)
• Nikolaas Enrique Reyna, DDS
• Nancy Reynolds, RN
• Rhonda Rayleen Rhoades, MA, LMHC, CTMH
• Kelcey P Rhodes, DDS
• Thomas Charles Rhodes, DDS
• Richard DO, PLLC (Richard Do, O.D.)

• General Practice Dentistry in Puyallup, WA
• Providers in Puyallup, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.