Provider Demographics
NPI:1124047030
Name:REID, SHARON LEE (DDS)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:LEE
Last Name:REID
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 STADIUM OAKS DR STE A
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-8961
Mailing Address - Country:US
Mailing Address - Phone:336-793-0577
Mailing Address - Fax:336-778-2437
Practice Address - Street 1:100 STADIUM OAKS DR STE A
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-8961
Practice Address - Country:US
Practice Address - Phone:336-793-0577
Practice Address - Fax:336-778-2437
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC46771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC56-1177617OtherFEDERAL TAX ID
NC6709770001Medicare NSC