Provider Demographics
NPI:1336242510
Name:DILL, REED DOUGLAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:REED
Middle Name:DOUGLAS
Last Name:DILL
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 1:171 LAKE ST N
Mailing Address - Street 2:
Mailing Address - City:BIG LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55309-9254
Mailing Address - Country:US
Mailing Address - Phone:763-263-3262
Mailing Address - Fax:763-263-7998
Practice Address - Street 1:171 LAKE ST N
Practice Address - Street 2:
Practice Address - City:BIG LAKE
Practice Address - State:MN
Practice Address - Zip Code:55309-9254
Practice Address - Country:US
Practice Address - Phone:763-263-3262
Practice Address - Fax:763-263-7998
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND105981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice