Provider Demographics
NPI:1306933361
Name:REYNOLDS, PRESTON LEE (DMD)
Entity type:Individual
Prefix:DR
First Name:PRESTON
Middle Name:LEE
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 ALFORD AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35226-3199
Mailing Address - Country:US
Mailing Address - Phone:205-823-0723
Mailing Address - Fax:205-823-0232
Practice Address - Street 1:1310 ALFORD AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35226-3199
Practice Address - Country:US
Practice Address - Phone:205-823-0723
Practice Address - Fax:205-823-0232
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL40611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice