Provider Demographics
NPI:1073662391
Name:REID, SHIRLEY E (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:E
Last Name:REID
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 N PALM ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-1946
Mailing Address - Country:US
Mailing Address - Phone:501-664-1230
Mailing Address - Fax:501-663-6307
Practice Address - Street 1:805 N PALM ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-1946
Practice Address - Country:US
Practice Address - Phone:501-664-1230
Practice Address - Fax:501-663-6307
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR22891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice