=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609303213
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SEAN REED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2017
-----------------------------------------------------
Last Update Date | 05/12/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8053 E FLORENTINE RD
-----------------------------------------------------
City | PRESCOTT VALLEY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86314-9423
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-772-9860
-----------------------------------------------------
Fax | 928-772-9866
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8053 E FLORENTINE RD
-----------------------------------------------------
City | PRESCOTT VALLEY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86314-9423
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-772-9860
-----------------------------------------------------
Fax | 928-772-9866
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ DENTIST
-----------------------------------------------------
Name | SEAN REED
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 928-772-9860
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | D8489
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------