Provider Demographics
NPI:1245461474
Name:REED, JOHN T (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:T
Last Name:REED
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 1:2509 W MARCH LN STE 240
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-8223
Mailing Address - Country:US
Mailing Address - Phone:209-478-4322
Mailing Address - Fax:209-478-4117
Practice Address - Street 1:2509 W MARCH LN STE 240
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-8223
Practice Address - Country:US
Practice Address - Phone:209-478-4322
Practice Address - Fax:209-478-4117
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58485122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist