Provider Demographics
NPI:1164033957
Name:HINER, REAGAN REXFORD (DDS)
Entity Type:Individual
Prefix:
First Name:REAGAN
Middle Name:REXFORD
Last Name:HINER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 CHRISTINE RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76302-2118
Mailing Address - Country:US
Mailing Address - Phone:713-829-3656
Mailing Address - Fax:
Practice Address - Street 1:412 S AVENUE D # B
Practice Address - Street 2:
Practice Address - City:BURKBURNETT
Practice Address - State:TX
Practice Address - Zip Code:76354-3542
Practice Address - Country:US
Practice Address - Phone:713-829-3656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36553122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist