MEDICARE: REED D. DILL, D.D.S. P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	D10598	MN

General Provider Information

NPI Number	:	1396971412
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REED D. DILL, D.D.S. P.A.

Provider Business Mailing Address
First Line	:	PO BOX 159
Second Line	:	171 LAKE ST NORTH
City	:	BIG LAKE
State	:	MN
Zip	:	55309-0159
Country	:	US
Telephone Number	:	763-263-3262
Fax Number	:	763-263-7998

Provider Business Practice Location Address
First Line	:	171 LAKE ST N
Second Line	:
City	:	BIG LAKE
State	:	MN
Zip	:	55309-9254
Country	:	US
Telephone Number	:	763-263-3262
Fax Number	:	763-263-7998

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. REED DOUGLAS DILL
Credential	:	DDS
Telephone Number	:	763-263-3262

Provider Enumeration Date	:	06/03/2009
Last Update Date	:	06/03/2009

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