Provider Demographics
NPI:1356640478
Name:REID, GEORGE PAUL (DMD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:PAUL
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 1:1749 TRELLIS DR
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-9348
Mailing Address - Country:US
Mailing Address - Phone:864-350-4577
Mailing Address - Fax:
Practice Address - Street 1:1306 OLD FAIRHOPE CT
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:SC
Practice Address - Zip Code:29745-9307
Practice Address - Country:US
Practice Address - Phone:803-628-1142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC70301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice