Steven Douglas Reddick, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN10135 Issued in FL

Practice address

440 S Buckmoore Rd
Lake Wales, FL 33853-2700

Phone

(863) 676-6507

Fax

(863) 678-0424

NPI assigned

Feb 7, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1425513600000",
    "number": "1669512182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "440 S BUCKMOORE RD",
            "city": "LAKE WALES",
            "state": "FL",
            "postal_code": "338532700",
            "telephone_number": "863-676-6507",
            "fax_number": "863-678-0424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "440 S BUCKMOORE RD",
            "city": "LAKE WALES",
            "state": "FL",
            "postal_code": "338532700",
            "telephone_number": "863-676-6507",
            "fax_number": "863-678-0424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REDDICK",
        "first_name": "STEVEN",
        "middle_name": "DOUGLAS",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-07",
        "last_updated": "2015-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN10135",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maurice Anthony Ramirez, D.O. PH.D.
• Manisha Rayavarapu, D.O.
• Real Asset Solutions Technologies & Investments LLC
• Jackson Steven Reddick, DMD
• Jacqueline Reddick
• Brenda Gail Register, RN
• Rehab Frontier, LLC
• Rehab Health Partners Lake Wales
• Rehab Specialists Inc. - Winter Haven
• Rocio Resuche I, SLPA

• General Practice Dentistry in Lake Wales, FL
• Providers in Lake Wales, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.