Provider Demographics
NPI:1811151640
Name:ATTISHA, REED (DMD, MD)
Entity type:Individual
Prefix:DR
First Name:REED
Middle Name:
Last Name:ATTISHA
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 SOUTH BELLEW AVENUE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601
Mailing Address - Country:US
Mailing Address - Phone:315-786-3990
Mailing Address - Fax:316-786-3991
Practice Address - Street 1:163 SOUTH BELLEW AVENUE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601
Practice Address - Country:US
Practice Address - Phone:315-786-3990
Practice Address - Fax:316-786-3991
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY50-056674122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist