Healthcare Provider Details

I. General information

NPI: 1285340109
Provider Name (Legal Business Name): LINDSEY ERIN REID
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2023
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460956 E 1023 RD
SALLISAW OK
74955-8974
US

IV. Provider business mailing address

460956 E 1023 RD
SALLISAW OK
74955-8974
US

V. Phone/Fax

Practice location:
  • Phone: 918-351-7135
  • Fax:
Mailing address:
  • Phone: 918-207-2813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number3882
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: