Provider Demographics
NPI:1962133561
Name:MCREYNOLDS, GRAYSON (DDS)
Entity type:Individual
Prefix:
First Name:GRAYSON
Middle Name:
Last Name:MCREYNOLDS
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 1:1607 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956-4735
Mailing Address - Country:US
Mailing Address - Phone:479-474-7076
Mailing Address - Fax:
Practice Address - Street 1:1607 MAIN ST
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-4735
Practice Address - Country:US
Practice Address - Phone:479-474-7076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR46211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice