Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 30. 021996 | OH |
NPI | 1053528174 |
---|---|
Provider Name | Dr. Charles Richard Reed IV |
First Address | Powell, OH 43065-8954 |
Second Address | Powell, OH 43065-8736 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2007 |
Last Update Date | 08/07/2007 |