Joseph Kenneth Reid, DMD
Individual provider Active NPI Dentist · Cottleville, MO
NPI 1750409132 · NPPES record last updated Jun 24, 2022
Key facts
- NPI
- 1750409132
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 2001014860 (MO)
- Practice address
- 150 Weiss Rd Ste 100
Cottleville, MO 63376-0045 - Phone
- (636) 477-0770
- Fax
- (636) 477-8115
- NPI assigned
- Mar 26, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
- Opted out of Medicare
- Yes, effective Feb 1, 2016 through Feb 1, 2028
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2001014860 | MO | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| WM J Miller DMD PC | Dentist | Past | Accepting new patients |
| David Guilbeault DMD Florissant Dental Group LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2001014860 | MO | Yes |
Addresses
Primary practice location
150 Weiss Rd Ste 100
Cottleville, MO 63376-0045
Mailing address
150 Weiss Rd Ste 100
Cottleville, MO 63376-0045
Phone (636) 477-0770
Other providers in Cottleville, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 24, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.