NPIMap

Organization Active NPI

Roger N Reynolds 111 DDS Ms PA

  • Dental Clinic/Center
  • Winston Salem, NC
National Provider Identifier
1801053475
Registry record updated May 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
3599 Issued in NC
Legal business name
ROGER N REYNOLDS 111 DDS MS PA
Practice address
3809 Forrestgate Dr
Suite a
Winston Salem, NC 27103-2982
Phone
(336) 768-9010
Fax
(336) 768-9011
NPI assigned
May 20, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2008

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

Authorized official

Name
Dr. Roger Nixon Reynolds III, DDS
Title
President
Phone
(336) 768-9010

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 3599 NC Primary

Addresses

Primary practice location

3809 Forrestgate Dr
Suite a
Winston Salem, NC 27103-2982

Mailing address

3809 Forrestgate Dr
Suite a
Winston Salem, NC 27103-2982
Phone (336) 768-9010

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1211241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211241600000",
    "number": "1801053475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3809 FORRESTGATE DR",
            "address_2": "SUITE A",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271032982",
            "telephone_number": "336-768-9010",
            "fax_number": "336-768-9011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3809 FORRESTGATE DR",
            "address_2": "SUITE A",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271032982",
            "telephone_number": "336-768-9010",
            "fax_number": "336-768-9011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROGER N REYNOLDS 111 DDS MS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-20",
        "last_updated": "2008-05-20",
        "status": "A",
        "authorized_official_last_name": "REYNOLDS",
        "authorized_official_first_name": "ROGER",
        "authorized_official_middle_name": "NIXON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "336-768-9010",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NC",
            "license": "3599",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2008; 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.