Provider Demographics
NPI:1669540084
Name:DAVID REAGAN & ROBERT SMITH DDS SMITH ROBERT F GEN PTR.
Entity type:Organization
Organization Name:DAVID REAGAN & ROBERT SMITH DDS SMITH ROBERT F GEN PTR.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:REAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-247-7040
Mailing Address - Street 1:11401 HEACOCK ST
Mailing Address - Street 2:SUITE 320
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-9998
Mailing Address - Country:US
Mailing Address - Phone:951-247-7040
Mailing Address - Fax:951-247-5092
Practice Address - Street 1:11401 HEACOCK ST
Practice Address - Street 2:SUITE 320
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-9998
Practice Address - Country:US
Practice Address - Phone:951-247-7040
Practice Address - Fax:951-247-5092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADB310291223G0001X
CADH321661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty