Provider Demographics
NPI:1659712354
Name:KREIDER, JOHN KEITH (DMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:KEITH
Last Name:KREIDER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:US ARMY DENTAL ACTIVITY
Mailing Address - Street 2:36000 DARNALL LOOP SUITE 1051
Mailing Address - City:FORT HOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76544
Mailing Address - Country:US
Mailing Address - Phone:254-287-2705
Mailing Address - Fax:
Practice Address - Street 1:US ARMY DENTAL ACTIVITY
Practice Address - Street 2:4431 68TH STREET
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-287-2705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-10
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-45021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice