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General NPI Number Information
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NPI Number | 1104176445
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Entity Type | Organization
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Legal Business Name | KIDDSTEETH PLLC
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Dates
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Enumeration Date | 09/13/2012
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Last Update Date | 09/13/2012
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Provider Practice Location Address
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Address Line | 60 FOUR MILE DR SUITE 10
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City | KALISPELL
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State | MT
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Zip | 59901-2663
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Country | US
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Telephone | 406-756-1142
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Fax | 406-756-1143
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Provider Business Mailing Address
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Address Line | 60 FOUR MILE DR SUITE 10
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City | KALISPELL
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State | MT
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Zip | 59901-2663
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Country | US
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Telephone | 406-756-1142
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Fax | 406-756-1143
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Authorized Official
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Title or Position | OWNER
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Name | DR. REED EDWARD THOMPSON
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Credential | DDS
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Telephone | 406-756-1142
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 2220
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 2005
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License Number State | MT
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