Provider Demographics
NPI:1336137926
Name:REID, ALLAN L (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:L
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 1:4828 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-4110
Mailing Address - Country:US
Mailing Address - Phone:812-471-9926
Mailing Address - Fax:812-471-9928
Practice Address - Street 1:4828 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-4110
Practice Address - Country:US
Practice Address - Phone:812-471-9926
Practice Address - Fax:812-471-9928
Is Sole Proprietor?:No
Enumeration Date:2005-10-09
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY47271223S0112X
IN12008873A1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
U28315Medicare UPIN
IN180400Medicare ID - Type UnspecifiedINDIANA MEDICARE