Provider Demographics
NPI:1164694626
Name:REED, ATEM AKWON EDWIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ATEM
Middle Name:AKWON EDWIN
Last Name:REED
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 1:7007 WYOMING BLVD NE STE A4
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-6941
Mailing Address - Country:US
Mailing Address - Phone:505-821-1433
Mailing Address - Fax:
Practice Address - Street 1:7007 WYOMING BLVD NE STE A4
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-6941
Practice Address - Country:US
Practice Address - Phone:505-821-1433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-25
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD33051223G0001X
CA567981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1164694626Medicaid