Provider Demographics
NPI:1235235425
Name:REID, DONNA (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:
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 1:6712 SULLIVAN WAY
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-6078
Mailing Address - Country:US
Mailing Address - Phone:571-970-4103
Mailing Address - Fax:571-970-4116
Practice Address - Street 1:300 N WASHINGTON ST
Practice Address - Street 2:SUITE 210
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2530
Practice Address - Country:US
Practice Address - Phone:703-653-4452
Practice Address - Fax:571-970-4116
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014110501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice