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General NPI Number Information
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NPI Number | 1104017326
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Entity Type | Organization
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Legal Business Name | J STANLEY REIDHEAD DDS PC
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 08/05/2007
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Provider Practice Location Address
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Address Line | 2076 E SOUTHERN AVE SUITE C-103
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City | TEMPE
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State | AZ
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Zip | 85282-7596
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Country | US
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Telephone | 480-839-0366
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Fax | 480-775-8608
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Provider Business Mailing Address
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Address Line | 2076 E SOUTHERN AVE SUITE C 103
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City | TEMPE
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State | AZ
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Zip | 85282-7520
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Country | US
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Telephone | 480-839-0366
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Fax | 480-775-8608
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSEPH STANLEY REIDHEAD
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Credential | D.D.S.
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Telephone | 480-839-0366
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 3344
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License Number State | AZ
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