Provider Demographics
NPI:1770739427
Name:REED, LACOLIS III (DDS)
Entity type:Individual
Prefix:DR
First Name:LACOLIS
Middle Name:
Last Name:REED
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 VALLEYGATE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILE
Mailing Address - State:NC
Mailing Address - Zip Code:28304
Mailing Address - Country:US
Mailing Address - Phone:919-485-7070
Mailing Address - Fax:910-485-1151
Practice Address - Street 1:2015 VALLEYGATE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3757
Practice Address - Country:US
Practice Address - Phone:910-485-7070
Practice Address - Fax:910-485-1151
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7896122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist