=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104060219
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WILLIAM TYRELL REID JR. D.D.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/21/2009
-----------------------------------------------------
Last Update Date | 12/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1183 SOUTH HAIRSTRON RD. SUITE D
-----------------------------------------------------
City | STONE MOUNTAIN
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30088
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-294-4012
-----------------------------------------------------
Fax | 404-508-8773
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1183-D S. HAIRSTRON RD. SUITE D
-----------------------------------------------------
City | STONE MOUNTAIN
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30088
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-294-4012
-----------------------------------------------------
Fax | 404-508-8773
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 7793
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------