Provider Demographics
NPI:1427136688
Name:REYNOLDS, CLINTON T (DDS)
Entity type:Individual
Prefix:DR
First Name:CLINTON
Middle Name:T
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6707 W CHARLESTON BLVD
Mailing Address - Street 2:STE 4
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146
Mailing Address - Country:US
Mailing Address - Phone:702-870-5783
Mailing Address - Fax:702-870-3193
Practice Address - Street 1:6707 W CHARLESTON BLVD
Practice Address - Street 2:STE 4
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146
Practice Address - Country:US
Practice Address - Phone:702-870-5783
Practice Address - Fax:702-870-3193
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4630122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist