Provider Demographics
NPI:1356434880
Name:REED, JOHN ROBERT (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROBERT
Last Name:REED
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 BEECHWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NEW WILMINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:16142-1417
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30 PINNACLE DR
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-3800
Practice Address - Country:US
Practice Address - Phone:814-223-9906
Practice Address - Fax:814-223-9912
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024279L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009887890004Medicaid
OH0751164Medicaid
PA0009887890003Medicaid
PA0009887890009Medicaid
PA0009887890007Medicaid
PA0009887890005Medicaid
PA0009887890006Medicaid