Provider Demographics
NPI:1356563274
Name:REED, DAVID E (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:E
Last Name:REED
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:MRS
Other - First Name:JANICE
Other - Middle Name:E
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1514 GARY ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:70113-3045
Mailing Address - Country:US
Mailing Address - Phone:318-424-1297
Mailing Address - Fax:318-425-8904
Practice Address - Street 1:1514 GARY ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:70113-3045
Practice Address - Country:US
Practice Address - Phone:318-424-1297
Practice Address - Fax:318-425-8904
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4218122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1842184Medicaid