Provider Demographics
NPI:1053469676
Name:REED, JOHN
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:REED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1241 LOMBARDI ACCESS RD
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-4059
Mailing Address - Country:US
Mailing Address - Phone:920-498-9088
Mailing Address - Fax:920-498-2146
Practice Address - Street 1:1241 LOMBARDI ACCESS RD
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-4059
Practice Address - Country:US
Practice Address - Phone:920-498-9088
Practice Address - Fax:920-498-2146
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI38771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice