Provider Demographics
NPI:1245252279
Name:REIDHEAD, JOSEPH STANLEY (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:STANLEY
Last Name:REIDHEAD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2076 E SOUTHERN AVE
Mailing Address - Street 2:SUITE C-103
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7596
Mailing Address - Country:US
Mailing Address - Phone:480-839-0366
Mailing Address - Fax:480-775-8608
Practice Address - Street 1:2076 E SOUTHERN AVE
Practice Address - Street 2:SUITE C-103
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7596
Practice Address - Country:US
Practice Address - Phone:480-839-0366
Practice Address - Fax:480-775-8608
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3344122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist