Provider Demographics
NPI:1356984579
Name:REED, DUSTIN (DMD)
Entity type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:
Last Name:REED
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 1:152 WENDELL LUNDY DR
Mailing Address - Street 2:
Mailing Address - City:BIMBLE
Mailing Address - State:KY
Mailing Address - Zip Code:40915-6179
Mailing Address - Country:US
Mailing Address - Phone:606-499-0634
Mailing Address - Fax:
Practice Address - Street 1:1608 CUMBERLAND FALLS HWY
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-2725
Practice Address - Country:US
Practice Address - Phone:606-523-2411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY102811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice