Provider Demographics
NPI:1659598613
Name:REESE, JOHN E III (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:E
Last Name:REESE
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11804
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29731-1804
Mailing Address - Country:US
Mailing Address - Phone:803-324-3101
Mailing Address - Fax:803-324-3101
Practice Address - Street 1:454 S ANDERSON RD
Practice Address - Street 2:SUITE 126
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-3392
Practice Address - Country:US
Practice Address - Phone:803-324-3101
Practice Address - Fax:803-324-3101
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ29498Medicaid