MEDICARE: MR. JAMES BOWERS 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	1223G0001X	General Practice Dentistry	12264	MA

General Provider Information

NPI Number	:	1497711741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES BOWERS REID DDS

Provider Business Mailing Address
First Line	:	107 HILLSIDE ROAD
Second Line	:
City	:	SO DEERFIELD
State	:	MA
Zip	:	01373
Country	:	US
Telephone Number	:	413-665-2272
Fax Number	:	413-665-9613

Provider Business Practice Location Address
First Line	:	4 PARK AVENUE
Second Line	:
City	:	SO DEERFIELD
State	:	MA
Zip	:	01373
Country	:	US
Telephone Number	:	413-665-4575
Fax Number	:	413-665-9613

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

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	07/08/2007

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