Healthcare Provider Details

I. General information

NPI: 1942380456
Provider Name (Legal Business Name): JAMES W REID D.D.S.,D.SC.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15419 NE 20TH ST SUITE 205
BELLEVUE WA
98007-3800
US

IV. Provider business mailing address

15419 NE 20TH ST SUITE 205
BELLEVUE WA
98007-3800
US

V. Phone/Fax

Practice location:
  • Phone: 425-643-5353
  • Fax: 425-643-1670
Mailing address:
  • Phone: 425-643-5353
  • Fax: 425-643-1670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number4788
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: