Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 3142610 | MI |
NPI | 1598896847 |
---|---|
Provider Name | Susan Reed |
First Address | Charleston, SC 29412-8307 |
Second Address | Charleston, SC 29425-9170 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2007 |
Last Update Date | 12/09/2013 |