Provider Demographics
NPI:1164894325
Name:PAUL REESE DDS PA
Entity Type:Organization
Organization Name:PAUL REESE DDS PA
Other - Org Name:REESE FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:REESE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:870-424-5900
Mailing Address - Street 1:301 SOUTH COLLEGE STREET
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-3944
Mailing Address - Country:US
Mailing Address - Phone:870-424-5900
Mailing Address - Fax:870-424-5906
Practice Address - Street 1:301 S COLLEGE ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-3944
Practice Address - Country:US
Practice Address - Phone:870-424-5900
Practice Address - Fax:870-424-5906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR30181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty