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General NPI Number Information
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NPI Number | 1205024817
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Entity Type | Organization
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Legal Business Name | BRUCE K. REEDER, DDS, PC
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Dates
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Enumeration Date | 10/09/2007
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Last Update Date | 10/09/2007
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Provider Practice Location Address
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Address Line | 5108 W GORE BLVD SUITE 4
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City | LAWTON
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State | OK
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Zip | 73505-6025
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Country | US
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Telephone | 580-248-7600
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Fax | 580-248-7633
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Provider Business Mailing Address
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Address Line | 5108 W GORE BLVD SUITE 4
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City | LAWTON
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State | OK
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Zip | 73505-6025
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Country | US
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Telephone | 580-248-7600
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Fax | 580-248-7633
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. MICHELE L. SPENCER
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Credential |
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Telephone | 580-248-7600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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