Provider Demographics
NPI:1245352285
Name:K T REESE DDS A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:K T REESE DDS A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAY
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:REESE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:435-882-0685
Mailing Address - Street 1:215 S 200 E
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-2714
Mailing Address - Country:US
Mailing Address - Phone:435-882-0685
Mailing Address - Fax:435-882-8720
Practice Address - Street 1:215 S 200 E
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-2714
Practice Address - Country:US
Practice Address - Phone:435-882-0685
Practice Address - Fax:435-882-8720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT129932-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty