Healthcare Provider Details

I. General information

NPI: 1609972363
Provider Name (Legal Business Name): WILLIAM R REED D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 N WESTWOOD BLVD
POPLAR BLUFF MO
63901-3318
US

IV. Provider business mailing address

1510 MEMORIAL DR
POPLAR BLUFF MO
63901-3342
US

V. Phone/Fax

Practice location:
  • Phone: 573-778-4630
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number013643
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number013643
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number013643
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: