Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 47786 | CA |
NPI | 1043233067 |
---|---|
Provider Name | Dr. Laura Kimberly Reid |
First Address | Mill Valley, CA 94941-3401 |
Second Address | Santa Rosa, CA 95407-6793 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 08/07/2007 |