=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427258342
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHAD MONROE REID D.D.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2007
-----------------------------------------------------
Last Update Date | 02/14/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 29933 E STATE HIGHWAY 51
-----------------------------------------------------
City | COWETA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74429-7684
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-279-7100
-----------------------------------------------------
Fax | 918-279-6430
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 29933 E HWY 51
-----------------------------------------------------
City | COWETA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-279-7100
-----------------------------------------------------
Fax | 918-279-6430
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 5958
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------