Provider Demographics
NPI:1811169998
Name:REYNOLDS, MILTON BRADFORD I (DDS)
Entity type:Individual
Prefix:DR
First Name:MILTON
Middle Name:BRADFORD
Last Name:REYNOLDS
Suffix:I
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 1:1336 HIGHWAY 42 EAST
Mailing Address - Street 2:
Mailing Address - City:PETAL
Mailing Address - State:MS
Mailing Address - Zip Code:39465-9415
Mailing Address - Country:US
Mailing Address - Phone:601-450-3371
Mailing Address - Fax:601-450-3373
Practice Address - Street 1:1336 HIGHWAY 42 EAST
Practice Address - Street 2:
Practice Address - City:PETAL
Practice Address - State:MS
Practice Address - Zip Code:39465-9415
Practice Address - Country:US
Practice Address - Phone:601-450-3371
Practice Address - Fax:601-450-3373
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2784-941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice