Healthcare Provider Details

I. General information

NPI: 1134381841
Provider Name (Legal Business Name): JOHN ALLAN REID D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1565 HOLLENBECK AVE #104
SUNNYVALE CA
94087
US

IV. Provider business mailing address

1565 HOLLENBECK AVE #104
SUNNYVALE CA
94087
US

V. Phone/Fax

Practice location:
  • Phone: 408-245-6010
  • Fax: 408-245-6018
Mailing address:
  • Phone: 408-245-6010
  • Fax: 408-245-6018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number12011577A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number101997
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number1870
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: