Provider Demographics
NPI:1962487603
Name:REED, RICHARD J (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:J
Last Name:REED
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 1:1009 E 20TH ST
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-2204
Mailing Address - Country:US
Mailing Address - Phone:417-623-2440
Mailing Address - Fax:417-626-7558
Practice Address - Street 1:1009 E 20TH ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-2204
Practice Address - Country:US
Practice Address - Phone:417-623-2440
Practice Address - Fax:417-626-7558
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO128201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO400311304Medicaid