Provider Demographics
NPI:1396953840
Name:REID, JACQUELINE SUSAN (DDS)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:SUSAN
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 1:390 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-2112
Mailing Address - Country:US
Mailing Address - Phone:973-635-9456
Mailing Address - Fax:973-635-9422
Practice Address - Street 1:390 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-2112
Practice Address - Country:US
Practice Address - Phone:973-635-9456
Practice Address - Fax:973-635-9422
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI01992100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist