Juan Camilo Reynolds, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12322159-9923 Issued in UT

Practice address

49 W Center St
Midvale, UT 84047-7364

Phone

(385) 887-9002

NPI assigned

Jul 28, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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 and National Provider Directory roles.

• Independence Dental, LLC

  • Dental Clinic/Center
  • Independence, KS
  • NPI 1104598721
  NPD Authorized official

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

{
    "created_epoch": "1627430400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627430400000",
    "number": "1891468641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 W SOUTH TEMPLE APT C108",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841041041",
            "telephone_number": "918-907-1335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "49 W CENTER ST",
            "city": "MIDVALE",
            "state": "UT",
            "postal_code": "840477364",
            "telephone_number": "385-887-9002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "JUAN",
        "middle_name": "CAMILO",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-07-28",
        "last_updated": "2021-07-28",
        "certification_date": "2021-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "12322159-9923",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rehab Specialists, LLC
• Elijah Edward Reives, MSW
• Reliant Services
• Rem Utah Inc.
• Marisa Renner
• Cierra Lee Rice
• Calli Richards
• Jana Nicole Richardson, LCSW
• Paul Murland Ricks, LCSW
• Ridgeline Counseling

• General Practice Dentistry in Midvale, UT
• Providers in Midvale, UT by specialty
• General Practice Dentistry in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2021; 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.