Jack Thomas Reynolds, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2016016886 Issued in MO

Practice address

4100 NE Vivion Rd
Kansas City, MO 64119-2811

Phone

(816) 454-6443

Fax

(816) 454-3145

NPI assigned

Jun 22, 2016

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

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

{
    "created_epoch": "1466553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466553600000",
    "number": "1942651880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4100 NE VIVION RD",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641192811",
            "telephone_number": "816-454-6443",
            "fax_number": "816-454-3145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 NE VIVION RD",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641192811",
            "telephone_number": "816-454-6443",
            "fax_number": "816-454-3145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "JACK",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-06-22",
        "last_updated": "2016-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "2016016886",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexa Reynders
• Julia Reynhout
• Amber R Reynolds
• Brandon Michael Reynolds, PHARMD
• Daniel K Reynolds, REGISTERED NURSE
• Kathleen Tay Reynolds, MS,PLPC
• Laura Shelby Reynolds, CAA
• Lori Beth Reynolds, MSW
• Lynda Karyl Reynolds, RN
• Richard R Reynolds, M.D.

• General Practice Dentistry in Kansas City, MO
• Providers in Kansas City, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 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.