Healthcare Provider Details

I. General information

NPI: 1790873263
Provider Name (Legal Business Name): AUSTIN BARRETT REED DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8558 KAPP DR
PEOSTA IA
52068
US

IV. Provider business mailing address

PO BOX 206
PEOSTA IA
52068-0206
US

V. Phone/Fax

Practice location:
  • Phone: 563-557-1563
  • Fax: 563-583-0581
Mailing address:
  • Phone: 563-557-1563
  • Fax: 563-583-0581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number08417
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: