MEDICARE: DR. JARED JAMES REID DMD

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	DS036158	PA

General Provider Information

NPI Number	:	1831173640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JARED JAMES REID DMD

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

Provider Business Practice Location Address
First Line	:	4 PARK AVENUE
Second Line	:
City	:	SOUTH 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	:	12/05/2005
Last Update Date	:	09/05/2013

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