Healthcare Provider Details

I. General information

NPI: 1174973218
Provider Name (Legal Business Name): DANIEL REID DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2016
Last Update Date: 08/04/2020
Certification Date: 08/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 HAWTHORN ST
NEW BEDFORD MA
02740-3429
US

IV. Provider business mailing address

81 HAWTHORN ST
NEW BEDFORD MA
02740-3429
US

V. Phone/Fax

Practice location:
  • Phone: 508-992-3737
  • Fax:
Mailing address:
  • Phone: 508-992-3737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN1857271
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberDN1857271
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: