Healthcare Provider Details

I. General information

NPI: 1164406054
Provider Name (Legal Business Name): R R REED D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2005
Last Update Date: 10/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

870 STATE FARM RD SUITE 103 B
BOONE NC
28607-4861
US

IV. Provider business mailing address

870 STATE FARM RD SUITE 103 B
BOONE NC
28607-4861
US

V. Phone/Fax

Practice location:
  • Phone: 828-268-9797
  • Fax: 828-265-7888
Mailing address:
  • Phone: 828-268-9797
  • Fax: 828-265-7888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number8906
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: