Provider Demographics
NPI:1477768026
Name:SUZANNE R. REEDY, D.D.S., P.C.
Entity Type:Organization
Organization Name:SUZANNE R. REEDY, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:R
Authorized Official - Last Name:REEDY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:765-282-2990
Mailing Address - Street 1:14001 W COUNTY ROAD 100 N
Mailing Address - Street 2:
Mailing Address - City:DALEVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47334-9506
Mailing Address - Country:US
Mailing Address - Phone:765-759-8338
Mailing Address - Fax:
Practice Address - Street 1:2301 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-4733
Practice Address - Country:US
Practice Address - Phone:765-282-2990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120099811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty