Provider Demographics
NPI:1437707197
Name:REYNOLDS, JOHN ZACHARY (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ZACHARY
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 1:5110 S MANHATTAN AVE UNIT 5103
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611-3456
Mailing Address - Country:US
Mailing Address - Phone:615-337-7992
Mailing Address - Fax:
Practice Address - Street 1:3180 REDEEMER WAY
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655-4245
Practice Address - Country:US
Practice Address - Phone:615-337-7992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN245121223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics