Provider Demographics
NPI:1063651107
Name:REID, DAVID MAURICE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MAURICE
Last Name:REID
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21902 LINDEN BLVD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11411-1619
Mailing Address - Country:US
Mailing Address - Phone:718-978-5938
Mailing Address - Fax:718-297-1930
Practice Address - Street 1:21902 LINDEN BLVD
Practice Address - Street 2:
Practice Address - City:CAMBRIA HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11411-1619
Practice Address - Country:US
Practice Address - Phone:718-978-5938
Practice Address - Fax:718-297-1930
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042252122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist