Provider Demographics
NPI:1417956566
Name:REEDY, LYLE S. CHAD (DDS)
Entity Type:Individual
Prefix:DR
First Name:LYLE S.
Middle Name:CHAD
Last Name:REEDY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:981 W SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:IL
Mailing Address - Zip Code:61032-6778
Mailing Address - Country:US
Mailing Address - Phone:815-235-5174
Mailing Address - Fax:815-232-5965
Practice Address - Street 1:981 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032-6778
Practice Address - Country:US
Practice Address - Phone:815-235-5174
Practice Address - Fax:815-232-5965
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice