Provider Demographics
NPI:1205024817
Name:BRUCE K. REEDER, DDS, PC
Entity Type:Organization
Organization Name:BRUCE K. REEDER, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-248-7600
Mailing Address - Street 1:5108 W GORE BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-6025
Mailing Address - Country:US
Mailing Address - Phone:580-248-7600
Mailing Address - Fax:580-248-7633
Practice Address - Street 1:5108 W GORE BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6025
Practice Address - Country:US
Practice Address - Phone:580-248-7600
Practice Address - Fax:580-248-7633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
1881725398OtherTYPE I NPI