MEDICARE: DR. BRUCE HOWARD REID DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	1383639922	UT

General Provider Information

NPI Number	:	1194732651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE HOWARD REID DDS

Provider Business Mailing Address
First Line	:	5292 S COLLEGE DR
Second Line	:	SUITE 203
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84123-2672
Country	:	US
Telephone Number	:	801-266-3000
Fax Number	:	801-262-6350

Provider Business Practice Location Address
First Line	:	5292 S COLLEGE DR
Second Line	:	SUITE 203
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84123-2672
Country	:	US
Telephone Number	:	801-266-3000
Fax Number	:	801-262-6350

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	07/08/2007

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