Provider Demographics
NPI:1538102637
Name:REED, DOUGLAS MARK (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:MARK
Last Name:REED
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 1:1406 KINGSLEY AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4590
Mailing Address - Country:US
Mailing Address - Phone:904-264-9911
Mailing Address - Fax:904-264-1010
Practice Address - Street 1:1406 KINGSLEY AVE
Practice Address - Street 2:SUITE C
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4590
Practice Address - Country:US
Practice Address - Phone:904-264-9911
Practice Address - Fax:904-264-1010
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN106011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice