Provider Demographics
NPI:1841921285
Name:REAGAN, SOFIA EMILIA (DMD)
Entity type:Individual
Prefix:
First Name:SOFIA
Middle Name:EMILIA
Last Name:REAGAN
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 1:440 NARRAGANSETT TRL
Mailing Address - Street 2:
Mailing Address - City:BUXTON
Mailing Address - State:ME
Mailing Address - Zip Code:04093-6505
Mailing Address - Country:US
Mailing Address - Phone:207-929-3900
Mailing Address - Fax:
Practice Address - Street 1:440 NARRAGANSETT TRL
Practice Address - Street 2:
Practice Address - City:BUXTON
Practice Address - State:ME
Practice Address - Zip Code:04093-6505
Practice Address - Country:US
Practice Address - Phone:207-929-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN49661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice