Provider Demographics
NPI:1861569816
Name:REYNOLDS, KERRIE A (DDS)
Entity type:Individual
Prefix:DR
First Name:KERRIE
Middle Name:A
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-4102
Mailing Address - Country:US
Mailing Address - Phone:608-782-7374
Mailing Address - Fax:608-784-4111
Practice Address - Street 1:1200 MAIN ST
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-4102
Practice Address - Country:US
Practice Address - Phone:608-782-7374
Practice Address - Fax:608-784-4111
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5417-015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist