Provider Demographics
NPI:1821347584
Name:REED, LORI ANN (RDHAP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:REED
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42687 RAVENSBOURNE PARK ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-3947
Mailing Address - Country:US
Mailing Address - Phone:510-364-2351
Mailing Address - Fax:
Practice Address - Street 1:42687 RAVENSBOURNE PARK ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-3947
Practice Address - Country:US
Practice Address - Phone:510-364-2351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-09
Last Update Date:2012-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA429124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist