Provider Demographics
NPI:1578322665
Name:EL REDA, KATHERINE (DDS)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:EL REDA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25710 ETON AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48125-1527
Mailing Address - Country:US
Mailing Address - Phone:201-713-8408
Mailing Address - Fax:
Practice Address - Street 1:2279 MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-9077
Practice Address - Country:US
Practice Address - Phone:937-419-2034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program