MEDICARE: REED CREEK DENTAL LLC

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1841901592
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REED CREEK DENTAL LLC

Provider Business Mailing Address
First Line	:	4213 COLUMBIA RD
Second Line	:
City	:	MARTINEZ
State	:	GA
Zip	:	30907-1481
Country	:	US
Telephone Number	:	706-868-6177
Fax Number	:

Provider Business Practice Location Address
First Line	:	4213 COLUMBIA RD
Second Line	:
City	:	MARTINEZ
State	:	GA
Zip	:	30907-1481
Country	:	US
Telephone Number	:	706-868-6177
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BLAKE TAYLOR ROSS
Credential	:	DMD
Telephone Number	:	705-868-6177

Provider Enumeration Date	:	12/13/2022
Last Update Date	:	12/13/2022

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Directions to “REED CREEK DENTAL LLC ” Practice Location

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