Provider Demographics
NPI:1750409132
Name:REID, JOSEPH KENNETH (DMD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:KENNETH
Last Name:REID
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 1:150 WEISS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:COTTLEVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63376-0045
Mailing Address - Country:US
Mailing Address - Phone:636-477-0770
Mailing Address - Fax:636-477-8115
Practice Address - Street 1:150 WEISS RD STE 100
Practice Address - Street 2:
Practice Address - City:COTTLEVILLE
Practice Address - State:MO
Practice Address - Zip Code:63376-0045
Practice Address - Country:US
Practice Address - Phone:636-477-0770
Practice Address - Fax:636-477-8115
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001014860122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist