Provider Demographics
NPI:1104017326
Name:J STANLEY REIDHEAD DDS PC
Entity Type:Organization
Organization Name:J STANLEY REIDHEAD DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:STANLEY
Authorized Official - Last Name:REIDHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-839-0366
Mailing Address - Street 1:2076 E SOUTHERN AVE
Mailing Address - Street 2:SUITE C 103
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7520
Mailing Address - Country:US
Mailing Address - Phone:480-839-0366
Mailing Address - Fax:480-775-8608
Practice Address - Street 1:2076 E SOUTHERN AVE
Practice Address - Street 2:SUITE C-103
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7596
Practice Address - Country:US
Practice Address - Phone:480-839-0366
Practice Address - Fax:480-775-8608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3344261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental