Provider Demographics
NPI:1407075047
Name:SADDORIS, REGINALD SHEROD (DMD)
Entity Type:Individual
Prefix:DR
First Name:REGINALD
Middle Name:SHEROD
Last Name:SADDORIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:REGINALD
Other - Middle Name:SHEROD
Other - Last Name:BORTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:857 FAIRWAY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-7604
Mailing Address - Country:US
Mailing Address - Phone:541-344-7684
Mailing Address - Fax:
Practice Address - Street 1:857 FAIRWAY VIEW DR
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-7604
Practice Address - Country:US
Practice Address - Phone:541-344-7684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD4770122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist