Provider Demographics
NPI:1881811461
Name:REAGIN, JESSE AKERS (DMD)
Entity type:Individual
Prefix:DR
First Name:JESSE
Middle Name:AKERS
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 1:111 SHADY BRANCH TRL
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-4930
Mailing Address - Country:US
Mailing Address - Phone:386-589-2081
Mailing Address - Fax:
Practice Address - Street 1:1737 NORTH CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117
Practice Address - Country:US
Practice Address - Phone:386-274-1450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN175301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice