Healthcare Provider Details

I. General information

NPI: 1427324409
Provider Name (Legal Business Name): KENNETH L. REED DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2012
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 SHADOW LN
LAS VEGAS NV
89106-4124
US

IV. Provider business mailing address

13885 N ZEPPELIN PL
ORO VALLEY AZ
85755-9405
US

V. Phone/Fax

Practice location:
  • Phone: 520-370-3693
  • Fax:
Mailing address:
  • Phone: 520-370-3693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number4183
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: