Provider Demographics
NPI:1679672224
Name:FOLSOM, REID ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:REID
Middle Name:ALAN
Last Name:FOLSOM
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 1:1336 5TH ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:WA
Mailing Address - Zip Code:99403-3314
Mailing Address - Country:US
Mailing Address - Phone:509-758-5011
Mailing Address - Fax:509-751-9125
Practice Address - Street 1:1336 5TH ST
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:WA
Practice Address - Zip Code:99403-3314
Practice Address - Country:US
Practice Address - Phone:509-758-5011
Practice Address - Fax:509-751-9125
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00007440122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5021787Medicaid
WA5007018Medicaid