Provider Demographics
NPI:1568026987
Name:EDWARD T REIDY DDS PC
Entity type:Organization
Organization Name:EDWARD T REIDY DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:T
Authorized Official - Last Name:REIDY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-449-8530
Mailing Address - Street 1:9280 MAST BLVD
Mailing Address - Street 2:NONE
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-2150
Mailing Address - Country:US
Mailing Address - Phone:619-449-8530
Mailing Address - Fax:619-449-8531
Practice Address - Street 1:9280 MAST BLVD
Practice Address - Street 2:NONE
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-2150
Practice Address - Country:US
Practice Address - Phone:619-449-8530
Practice Address - Fax:619-449-8531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-01
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental