Provider Demographics
NPI:1295009967
Name:SHARON L. REID, DDS, PA
Entity type:Organization
Organization Name:SHARON L. REID, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-778-2477
Mailing Address - Street 1:100 STADIUM OAKS DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-8961
Mailing Address - Country:US
Mailing Address - Phone:336-778-2477
Mailing Address - Fax:336-778-2437
Practice Address - Street 1:100 STADIUM OAKS DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-8961
Practice Address - Country:US
Practice Address - Phone:336-778-2477
Practice Address - Fax:336-778-2437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-28
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC46771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6709770001Medicare NSC