Provider Demographics
NPI:1154389526
Name:THOMPSON, REED E (DDS)
Entity type:Individual
Prefix:
First Name:REED
Middle Name:E
Last Name:THOMPSON
Suffix:
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 1:900 W RESERVE DR
Mailing Address - Street 2:APT 319
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-2165
Mailing Address - Country:US
Mailing Address - Phone:406-871-8734
Mailing Address - Fax:
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:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1057126800000X
MT20051223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No126800000XDental ProvidersDental Assistant