Provider Demographics
NPI:1568817088
Name:E. LISA REID DMD, PLLC
Entity Type:Organization
Organization Name:E. LISA REID DMD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELEANOR
Authorized Official - Middle Name:
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-675-6606
Mailing Address - Street 1:63 FORT GREENE PL
Mailing Address - Street 2:APT 8
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-1241
Mailing Address - Country:US
Mailing Address - Phone:347-675-6606
Mailing Address - Fax:212-614-3223
Practice Address - Street 1:130 E 18TH ST
Practice Address - Street 2:SUITE 1M
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-2416
Practice Address - Country:US
Practice Address - Phone:347-675-6606
Practice Address - Fax:212-614-3223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-03
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054312261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental