Healthcare Provider Details

I. General information

NPI: 1669548251
Provider Name (Legal Business Name): CARTER C REESE DDS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9401 36TH AVE N
NEW HOPE MN
55427
US

IV. Provider business mailing address

9401 36TH AVE N
NEW HOPE MN
55427
US

V. Phone/Fax

Practice location:
  • Phone: 763-544-8745
  • Fax: 763-544-9702
Mailing address:
  • Phone: 763-544-8745
  • Fax: 763-544-9702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. KAREN JACOBSON REESE
Title or Position: ORTHODONTIST OWNER
Credential: DDS MS
Phone: 763-544-8745