Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 24491 | TX |
NPI | 1003077819 |
---|---|
Provider Name | Dr. Brian Reeder |
First Address | Kingwood, TX 77345-3036 |
Second Address | Livingston, TX 77351-8899 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2008 |
Last Update Date | 22/05/2013 |