Provider Demographics
NPI:1396971412
Name:REED D. DILL, D.D.S. P.A.
Entity type:Organization
Organization Name:REED D. DILL, D.D.S. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REED
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:DILL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:763-263-3262
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:171 LAKE ST NORTH
Mailing Address - City:BIG LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55309-0159
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND10598261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental