Jeffrey Reynolds, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6076 Issued in LA

Practice address

14243 Hwy 90
Boutte, LA 70394

Phone

(985) 785-0488

NPI assigned

Jul 15, 2010

Sex

Male

Sole proprietor

Yes

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 15, 2010.

{
    "created_epoch": "1279152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1279152000000",
    "number": "1982917217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14243 HWY 90",
            "city": "BOUTTE",
            "state": "LA",
            "postal_code": "70394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14243 HWY 90",
            "city": "BOUTTE",
            "state": "LA",
            "postal_code": "70394",
            "telephone_number": "985-785-0488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "JEFFREY",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-07-15",
        "last_updated": "2010-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "LA",
            "license": "6076",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dana Delgado Patterson, PHARMD
• Kanisha Paul
• Joleen Thi Phan, DMD
• Pontchartrain Bone & Joint Clinic, LTD.
• Michelle Yvette Revader Dunmiles, PHARMD
• Katie Marie Roussell, M.A, CCC-SLP
• Jordan Ashley Samaha
• Keli Doles Sanders, DPT
• Sav Mor Drugs Inc
• Michael Thomas Simmons, PHARMD

• All providers in Boutte, LA
• General Practice Dentistry in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.