Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0004X | Dentist Anesthesiologist | 4183 | AZ |
NPI | 1427324409 |
---|---|
Provider Name | Dr. Kenneth L. Reed |
First Address | Tucson, AZ 85754-5883 |
Second Address | Tarzana, CA 91356-1351 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2012 |
Last Update Date | 11/02/2016 |