Provider Demographics
NPI:1760559025
Name:REED, KENNETH NOEL JR (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:NOEL
Last Name:REED
Suffix:JR
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:K
Other - Middle Name:NOEL
Other - Last Name:REED
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DDS MS
Mailing Address - Street 1:451 PEBBLE CREEK DRIVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110
Mailing Address - Country:US
Mailing Address - Phone:601-898-8000
Mailing Address - Fax:601-898-8002
Practice Address - Street 1:451 PEBBLE CREEK DRIVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110
Practice Address - Country:US
Practice Address - Phone:601-898-8000
Practice Address - Fax:601-898-8002
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS28831223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics