Provider Demographics
NPI:1134610926
Name:POPPLE, REID WESTON (DMD)
Entity type:Individual
Prefix:DR
First Name:REID
Middle Name:WESTON
Last Name:POPPLE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:773 VEDADO WAY NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-1723
Mailing Address - Country:US
Mailing Address - Phone:770-241-9448
Mailing Address - Fax:
Practice Address - Street 1:2992 STONE MOUNTAIN HWY
Practice Address - Street 2:A100
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078
Practice Address - Country:US
Practice Address - Phone:770-972-1039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN015631122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist