Provider Demographics
NPI:1679926869
Name:REID, MAKAYLA DAWN (DDS)
Entity type:Individual
Prefix:
First Name:MAKAYLA
Middle Name:DAWN
Last Name:REID
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 BARRETT AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-3560
Mailing Address - Country:US
Mailing Address - Phone:317-509-2363
Mailing Address - Fax:
Practice Address - Street 1:6760 ALLEN RD
Practice Address - Street 2:#101
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-2078
Practice Address - Country:US
Practice Address - Phone:317-509-2363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901022033122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist