Provider Demographics
NPI:1184091084
Name:DR. SHIRLEY REID, DDS
Entity type:Organization
Organization Name:DR. SHIRLEY REID, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:W
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-664-1230
Mailing Address - Street 1:805 N PALM ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-1946
Mailing Address - Country:US
Mailing Address - Phone:501-664-1230
Mailing Address - Fax:501-663-6307
Practice Address - Street 1:805 N PALM ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-1946
Practice Address - Country:US
Practice Address - Phone:501-664-1230
Practice Address - Fax:501-663-6307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR22891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty