Provider Demographics
NPI:1952568966
Name:REAGIN, KENNETH BRITT (DMD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:BRITT
Last Name:REAGIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 W 4TH NORTH STREET
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483
Mailing Address - Country:US
Mailing Address - Phone:843-871-4411
Mailing Address - Fax:843-875-4508
Practice Address - Street 1:401 W 4TH N STREET
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483
Practice Address - Country:US
Practice Address - Phone:843-871-4411
Practice Address - Fax:843-875-4508
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC41771223X0400X
SCFR0411467122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
No122300000XDental ProvidersDentist