Provider Demographics
NPI:1053528174
Name:REED, CHARLES RICHARD IV (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:RICHARD
Last Name:REED
Suffix:IV
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1453 WREN LN
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-8954
Mailing Address - Country:US
Mailing Address - Phone:614-781-1802
Mailing Address - Fax:740-548-9918
Practice Address - Street 1:86 HIDDEN RAVINES DR
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-8736
Practice Address - Country:US
Practice Address - Phone:740-548-9912
Practice Address - Fax:740-548-9918
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30. 0219961223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics