Provider Demographics
NPI:1750747200
Name:J.C. REAGAN D.D.S., P.C.
Entity type:Organization
Organization Name:J.C. REAGAN D.D.S., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CURTIS
Authorized Official - Last Name:REAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:956-245-0105
Mailing Address - Street 1:200 S OAKRIDGE DR
Mailing Address - Street 2:STE 106
Mailing Address - City:HUDSON OAKS
Mailing Address - State:TX
Mailing Address - Zip Code:76087-1794
Mailing Address - Country:US
Mailing Address - Phone:956-245-0105
Mailing Address - Fax:
Practice Address - Street 1:200 S OAKRIDGE DR
Practice Address - Street 2:STE 106
Practice Address - City:HUDSON OAKS
Practice Address - State:TX
Practice Address - Zip Code:76087-1794
Practice Address - Country:US
Practice Address - Phone:956-245-0105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX299801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty