Provider Demographics
NPI:1396196473
Name:REED, KELSEY (RDH)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:REED
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6413 HARLAN DR
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-7744
Mailing Address - Country:US
Mailing Address - Phone:541-274-9375
Mailing Address - Fax:
Practice Address - Street 1:21300 HIGHWAY 62 STE 100
Practice Address - Street 2:
Practice Address - City:SHADY COVE
Practice Address - State:OR
Practice Address - Zip Code:97539-7707
Practice Address - Country:US
Practice Address - Phone:541-878-2115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1223G0001X122300000X
OR124Q00000X124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No124Q00000XDental ProvidersDental Hygienist