Shawn E Reese, DDS MS PC

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

08003 Issued in IA

Practice address

3434 Kimball Avenue
Waterloo, IA 50702

Phone

(319) 236-0861

Fax

(319) 236-0410

NPI assigned

Oct 4, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in IA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1700971538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3434 KIMBALL AVENUE",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "50702",
            "telephone_number": "319-236-0861",
            "fax_number": "319-236-0410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3434 KIMBALL AVENUE",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "50702",
            "telephone_number": "319-236-0861",
            "fax_number": "319-236-0410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REESE",
        "first_name": "SHAWN",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "DDS MS PC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "IA",
            "license": "08003",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0200550",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "23960",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "64004970",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Reagan Linae Rathe, PHARMD
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• Suresh Katapalli Reddy, MD
• David Carter Redfern, MD
• Annette Marie Redman, DOCTOR OF AUDIOLOGY
• Prudhvi Regula
• Kristen Kay Reichert, LISW
• Ashley Lyn Reid, D.C.
• Shelby Reid, PHARMD
• Vincent Junior Reid, M.D.

• Periodontics in Waterloo, IA
• Providers in Waterloo, IA by specialty
• Periodontics in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.