Provider Demographics
NPI:1134129661
Name:REAGAN, PAUL DAVIDSON (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DAVIDSON
Last Name:REAGAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 VINEYARD CT
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-2486
Mailing Address - Country:US
Mailing Address - Phone:817-453-7512
Mailing Address - Fax:
Practice Address - Street 1:1711 DOOLITTLE AVE
Practice Address - Street 2:
Practice Address - City:NAVAL AIR STATION/ JRB
Practice Address - State:TX
Practice Address - Zip Code:76127-1133
Practice Address - Country:US
Practice Address - Phone:817-782-5718
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX013018122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist