Provider Demographics
NPI:1760861595
Name:REEKAY PLLC
Entity Type:Organization
Organization Name:REEKAY PLLC
Other - Org Name:LAGUNA DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL DENTIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:REE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:650-644-9922
Mailing Address - Street 1:1818 W IRVING BLVD
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-6880
Mailing Address - Country:US
Mailing Address - Phone:650-644-9922
Mailing Address - Fax:
Practice Address - Street 1:1818 W IRVING BLVD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-6880
Practice Address - Country:US
Practice Address - Phone:650-644-9922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX286851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty