Provider Demographics
NPI:1528219540
Name:REID, DOUGLAS M (DMD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:M
Last Name:REID
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 1:575 RIVERGATE LN UNIT 98
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-7488
Mailing Address - Country:US
Mailing Address - Phone:970-449-0824
Mailing Address - Fax:
Practice Address - Street 1:575 RIVERGATE LN UNIT 98
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7488
Practice Address - Country:US
Practice Address - Phone:970-449-0824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE67951223S0112X
CODEN.002038441223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery