Provider Demographics
NPI:1558899203
Name:ST. DENIS, RAEGAN ADAIR (DMD)
Entity Type:Individual
Prefix:DR
First Name:RAEGAN
Middle Name:ADAIR
Last Name:ST. DENIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:RAEGAN
Other - Middle Name:ADAIR
Other - Last Name:PAIGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:104 RANSOM TRCE
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-2093
Mailing Address - Country:US
Mailing Address - Phone:859-519-8377
Mailing Address - Fax:
Practice Address - Street 1:3101 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1599
Practice Address - Country:US
Practice Address - Phone:859-963-2342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2017-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9921122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist