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General NPI Number Information
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NPI Number | 1972918191
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Entity Type | Individual
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Provider Name | VAN REID D.D.S
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Gender | Female
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Dates
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Enumeration Date | 06/26/2014
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Last Update Date | 11/25/2019
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Provider Practice Location Address
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Address Line | 17224 SE 272ND ST
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City | COVINGTON
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State | WA
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Zip | 98042-4953
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Country | US
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Telephone | 253-630-4400
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Fax |
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Provider Business Mailing Address
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Address Line | 27816 214TH AVE SE
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City | MAPLE VALLEY
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State | WA
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Zip | 98038-3131
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Country | US
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Telephone | 214-926-6723
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 30126
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DE60945290
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License Number State | WA
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