Provider Demographics
NPI:1255475232
Name:REID, JOHN H (DMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:H
Last Name:REID
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 1:1156 LEXINGTON RD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-8808
Mailing Address - Country:US
Mailing Address - Phone:502-863-9703
Mailing Address - Fax:502-863-9778
Practice Address - Street 1:1156 LEXINGTON RD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-8808
Practice Address - Country:US
Practice Address - Phone:502-863-9703
Practice Address - Fax:502-863-9778
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY63801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice