Provider Demographics
NPI:1952682734
Name:KYLE J. REED, DMD, PLLC
Entity Type:Organization
Organization Name:KYLE J. REED, DMD, PLLC
Other - Org Name:DOGWOOD PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:601-672-6756
Mailing Address - Street 1:151 E METRO DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-4402
Mailing Address - Country:US
Mailing Address - Phone:601-992-0007
Mailing Address - Fax:
Practice Address - Street 1:151 E METRO DR
Practice Address - Street 2:SUITE 201
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-4402
Practice Address - Country:US
Practice Address - Phone:601-992-0007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3511-091223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08406567Medicaid