Healthcare Provider Details

I. General information

NPI: 1295872299
Provider Name (Legal Business Name): STEPHEN ANDREW REID D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1844 SAN MIGUEL DR SUITE # 309
WALNUT CREEK CA
94596-4962
US

IV. Provider business mailing address

1844 SAN MIGUEL DR SUITE # 309
WALNUT CREEK CA
94596-4962
US

V. Phone/Fax

Practice location:
  • Phone: 925-938-5633
  • Fax: 925-938-5201
Mailing address:
  • Phone: 925-938-5633
  • Fax: 925-938-5201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberD22176
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: