Provider Demographics
NPI:1972890978
Name:BONNER, REAGAN ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:REAGAN
Middle Name:ALLEN
Last Name:BONNER
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 1:404 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:DUMAS
Mailing Address - State:TX
Mailing Address - Zip Code:79029
Mailing Address - Country:US
Mailing Address - Phone:806-935-6811
Mailing Address - Fax:806-935-9080
Practice Address - Street 1:404 E 1ST ST
Practice Address - Street 2:
Practice Address - City:DUMAS
Practice Address - State:TX
Practice Address - Zip Code:79029
Practice Address - Country:US
Practice Address - Phone:806-935-6811
Practice Address - Fax:806-935-9080
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX270861223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice