Provider Demographics
NPI:1649462417
Name:REAGIN, LAUREN OLINTO (DMD)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:OLINTO
Last Name:REAGIN
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 1:1370 CENTER DR
Mailing Address - Street 2:STE 101
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-4132
Mailing Address - Country:US
Mailing Address - Phone:770-671-9199
Mailing Address - Fax:770-671-9299
Practice Address - Street 1:1370 CENTER DR
Practice Address - Street 2:STE 101
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-4132
Practice Address - Country:US
Practice Address - Phone:770-671-9199
Practice Address - Fax:770-671-9299
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0126711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice