Provider Demographics
NPI:1508870296
Name:REID, ROBERT M (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:REID
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 OXFORD RD
Mailing Address - Street 2:
Mailing Address - City:FERN PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32730-2115
Mailing Address - Country:US
Mailing Address - Phone:407-831-1819
Mailing Address - Fax:407-831-4393
Practice Address - Street 1:130 OXFORD RD
Practice Address - Street 2:
Practice Address - City:FERN PARK
Practice Address - State:FL
Practice Address - Zip Code:32730-2115
Practice Address - Country:US
Practice Address - Phone:407-831-1819
Practice Address - Fax:407-831-4393
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00046861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice