Healthcare Provider Details

I. General information

NPI: 1336137926
Provider Name (Legal Business Name): ALLAN L REID DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2005
Last Update Date: 12/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4828 LINCOLN AVE
EVANSVILLE IN
47715-4110
US

IV. Provider business mailing address

4828 LINCOLN AVE
EVANSVILLE IN
47715-4110
US

V. Phone/Fax

Practice location:
  • Phone: 812-471-9926
  • Fax: 812-471-9928
Mailing address:
  • Phone: 812-471-9926
  • Fax: 812-471-9928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number4727
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number12008873A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: