Jack J. Reynolds Jr. D.D.S., LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

12007171A Issued in IN

Legal business name

JACK J. REYNOLDS JR. D.D.S., LLC

Practice address

1002 Oak Dr
Richmond, IN 47374-1916

Phone

(765) 966-7602

Fax

(765) 962-1066

NPI assigned

Feb 26, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Jack J. Reynolds Jr., D.D.S.NPI 1295825123

Title

Owner

Phone

(765) 966-7602

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jack J. Reynolds Jr., DDS

  • Pediatric Dentistry
  • Richmond, IN
  • NPI 1295825123
  NPD (past) Authorized official

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

{
    "created_epoch": "1456444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1456444800000",
    "number": "1932569415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1002 OAK DR",
            "city": "RICHMOND",
            "state": "IN",
            "postal_code": "473741916",
            "telephone_number": "765-966-7602",
            "fax_number": "765-962-1066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1002 OAK DR",
            "city": "RICHMOND",
            "state": "IN",
            "postal_code": "473741916",
            "telephone_number": "765-966-7602",
            "fax_number": "765-962-1066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK J. REYNOLDS JR. D.D.S., LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-26",
        "last_updated": "2016-02-26",
        "status": "A",
        "authorized_official_last_name": "REYNOLDS",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "765-966-7602",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "IN",
            "license": "12007171A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100255900",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Internists, Inc.
• Bernida Lucile Iqbal, DDS
• Billie Ann Isaacs, MA, BCBA
• Heather N Isaacs, PTA
• Amy Izod
• Amanda Jack
• Douglas Jackson, NP
• Morgan Jackson
• John P Jacobs, M.D.
• James E Swonder MD PC

• Pediatric Dentistry in Richmond, IN
• Providers in Richmond, IN by specialty
• Pediatric Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2016; 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.