Provider Demographics
NPI:1831899046
Name:JOHN F. REARDON DDS, PA
Entity type:Organization
Organization Name:JOHN F. REARDON DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:FORAN
Authorized Official - Last Name:REARDON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:651-216-2072
Mailing Address - Street 1:333 MAIN ST N STE 111
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-5054
Mailing Address - Country:US
Mailing Address - Phone:651-439-6125
Mailing Address - Fax:651-439-0038
Practice Address - Street 1:333 MAIN ST N STE 111
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-5054
Practice Address - Country:US
Practice Address - Phone:651-439-6125
Practice Address - Fax:651-439-0038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental