Wadud Reza, D.D.S

Primary specialty

DentistTaxonomy code 122300000X

License

054818 Issued in NY

Practice address

2 Business Park CT
Utica, NY 13502-6308

Phone

(315) 982-0692

Fax

(315) 732-0481

NPI assigned

Aug 17, 2006

Last updated

Jan 2, 2014By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1388620800000",
    "number": "1063526226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 BUSINESS PARK CT",
            "city": "UTICA",
            "state": "NY",
            "postal_code": "135026308",
            "telephone_number": "315-982-0692",
            "fax_number": "315-732-0481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 BUSINESS PARK CT",
            "city": "UTICA",
            "state": "NY",
            "postal_code": "135026308",
            "telephone_number": "315-982-0692",
            "fax_number": "315-732-0481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REZA",
        "first_name": "WADUD",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-17",
        "last_updated": "2014-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "054818",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "20799",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03236220",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "20-1660371",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "219-0516",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Colleen K Reynolds, PT
• Heather A Reynolds, LCSW
• Justin Fredrick Reynolds
• Kelly Marie Reynolds, RN
• Sydney Ariana Reynolds
• Michelle L Rhymestine, PA
• Richard Lee Obrien DO PC
• Richard P Pascucci (Towpath Vision Care)
• Trista Richardson, OTR/L
• Bethany Ann Rickard, LMSW

• Dentist in Utica, NY
• Providers in Utica, NY by specialty
• Dentist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.