Provider Demographics
NPI:1790898708
Name:REED, JAMES ERVIN (DDS, MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ERVIN
Last Name:REED
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10620 SE 20TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-7131
Mailing Address - Country:US
Mailing Address - Phone:425-641-5560
Mailing Address - Fax:425-641-5563
Practice Address - Street 1:1855 156TH AVE NE STE 101
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-4386
Practice Address - Country:US
Practice Address - Phone:425-641-5560
Practice Address - Fax:425-641-5563
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000083321223S0112X
WAMD00035615204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Not Answered204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU85316Medicare UPIN