Provider Demographics
NPI:1720087422
Name:REDING, PERRY WILLIAM (DDS, MD)
Entity Type:Individual
Prefix:
First Name:PERRY
Middle Name:WILLIAM
Last Name:REDING
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1917 NE 7TH CIR
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-9815
Mailing Address - Country:US
Mailing Address - Phone:360-210-5748
Mailing Address - Fax:
Practice Address - Street 1:1917 NE 7TH CIR
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-9815
Practice Address - Country:US
Practice Address - Phone:360-210-5748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5520MD207P00000X
TXG5520207Q00000X
NM95-130207P00000X
WAMD00048129207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMV9105Medicaid
TXG5520MDOtherMEDICAL LICENSE NUMBER
TX137290608Medicaid
TX137290609Medicaid
NM34668Medicaid
NMV9105Medicaid
TX137290608Medicaid