Provider Demographics
NPI:1104060219
Name:REID, WILLIAM TYRELL JR (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:TYRELL
Last Name:REID
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1183-D S. HAIRSTRON RD.
Mailing Address - Street 2:SUITE D
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30088
Mailing Address - Country:US
Mailing Address - Phone:404-294-4012
Mailing Address - Fax:404-508-8773
Practice Address - Street 1:1183 SOUTH HAIRSTRON RD.
Practice Address - Street 2:SUITE D
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30088
Practice Address - Country:US
Practice Address - Phone:404-294-4012
Practice Address - Fax:404-508-8773
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7793122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist