Provider Demographics
NPI:1518564210
Name:MCNERNEY, REAGAN (DMD)
Entity Type:Individual
Prefix:
First Name:REAGAN
Middle Name:
Last Name:MCNERNEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 W FREEDOM DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MS
Mailing Address - Zip Code:39645-7295
Mailing Address - Country:US
Mailing Address - Phone:601-657-4326
Mailing Address - Fax:601-657-8867
Practice Address - Street 1:102 W FREEDOM DR
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MS
Practice Address - Zip Code:39645-7295
Practice Address - Country:US
Practice Address - Phone:601-657-4326
Practice Address - Fax:601-657-8867
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN122201223G0001X
SC98081223G0001X
MS4165201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice