Provider Demographics
NPI:1659421196
Name:RAGAN, BOBBY W (DDS)
Entity Type:Individual
Prefix:DR
First Name:BOBBY
Middle Name:W
Last Name:RAGAN
Suffix:
Gender:M
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:PO BOX 86
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:TX
Mailing Address - Zip Code:75436-0086
Mailing Address - Country:US
Mailing Address - Phone:903-674-5165
Mailing Address - Fax:903-674-5165
Practice Address - Street 1:195 FIRST ST. SOUTHWEST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:TX
Practice Address - Zip Code:75436
Practice Address - Country:US
Practice Address - Phone:903-674-5165
Practice Address - Fax:903-674-5165
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX146811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice