Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | D11048 | OR |
NPI | 1124686068 |
---|---|
Provider Name | Daniel Halsey Reynolds |
First Address | Albany, OR 97321-3846 |
Second Address | Albany, OR 97321-3846 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2019 |
Last Update Date | 11/06/2019 |