Derrick Reid, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12012614A Issued in IN

Practice address

54310 Mystique CT
Mishawaka, IN 46545-1824

Phone

(615) 327-9400

NPI assigned

Feb 28, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1336277656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "54310 MYSTIQUE CT",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465451824",
            "telephone_number": "615-327-9400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "54310 MYSTIQUE CT",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465451824",
            "telephone_number": "615-327-9400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REID",
        "first_name": "DERRICK",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-28",
        "last_updated": "2023-11-27",
        "certification_date": "2023-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "8159",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12012614A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Haley Redlin
• Kennedy Faith Reed
• Charles Albert Reger, M.A.
• Paige Nicole Regina, P.T.A.
• Rehabilitation Hospital of Northern Indiana, LLC
• Isabella Reid
• Taylor Reid
• James E Reidy, M.D.
• Reliable Medical Supply LLC
• Haylee Marie Rella

• General Practice Dentistry in Mishawaka, IN
• Providers in Mishawaka, IN by specialty
• General Practice Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; 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.