Provider Demographics
NPI:1114154143
Name:TALEB, REDA (DMD)
Entity Type:Individual
Prefix:
First Name:REDA
Middle Name:
Last Name:TALEB
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 BANK ST SE APT 2103
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-3905
Mailing Address - Country:US
Mailing Address - Phone:734-644-4156
Mailing Address - Fax:
Practice Address - Street 1:7-174 MOOS TOWER,
Practice Address - Street 2:515 DELAWARE ST SE
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-624-9959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR4211223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery