Provider Demographics
NPI:1437922572
Name:REAGIN, KATELYN MARIE
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:MARIE
Last Name:REAGIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1165 E BULLOCH ST UNIT F312
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84780-3360
Mailing Address - Country:US
Mailing Address - Phone:720-413-0704
Mailing Address - Fax:
Practice Address - Street 1:3272 E RIO VIRGIN RD
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:AZ
Practice Address - Zip Code:86432-3200
Practice Address - Country:US
Practice Address - Phone:928-645-9675
Practice Address - Fax:928-645-1414
Is Sole Proprietor?:No
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist