Provider Demographics
NPI:1134381841
Name:REID, JOHN ALLAN (DMD)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ALLAN
Last Name:REID
Suffix:
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 1:1565 HOLLENBECK AVE #104
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087
Mailing Address - Country:US
Mailing Address - Phone:408-245-6010
Mailing Address - Fax:408-245-6018
Practice Address - Street 1:1565 HOLLENBECK AVE #104
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087
Practice Address - Country:US
Practice Address - Phone:408-245-6010
Practice Address - Fax:408-245-6018
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011577A1223S0112X
CA101997204E00000X
CA1870207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1134381841Medicaid