Provider Demographics
NPI:1104176445
Name:KIDDSTEETH PLLC
Entity type:Organization
Organization Name:KIDDSTEETH PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REED
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:406-756-1142
Mailing Address - Street 1:60 FOUR MILE DR
Mailing Address - Street 2:SUITE 10
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-2663
Mailing Address - Country:US
Mailing Address - Phone:406-756-1142
Mailing Address - Fax:406-756-1143
Practice Address - Street 1:60 FOUR MILE DR
Practice Address - Street 2:SUITE 10
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-2663
Practice Address - Country:US
Practice Address - Phone:406-756-1142
Practice Address - Fax:406-756-1143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT22201223P0221X
MT20051223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1154389526Medicaid
MT1619030186Medicaid