Provider Demographics
NPI:1922400415
Name:REID, DONALD
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:
Last Name:REID
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10330 DONNER PASS RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-0424
Mailing Address - Country:US
Mailing Address - Phone:530-587-9560
Mailing Address - Fax:
Practice Address - Street 1:10330 DONNER PASS RD
Practice Address - Street 2:SUITE A
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-0424
Practice Address - Country:US
Practice Address - Phone:530-587-9560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA28797122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist