Individual
ANISSA LYNN REAGOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1210 DOUGLASS RD, NACOGDOCHES, TX 75964-4904
(936) 560-1122
(936) 560-1631
Mailing address
PO BOX 632040, NACOGDOCHES, TX 75963-2040
(936) 560-1122
(936) 560-1631
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
19573
TX
1223G0001X
General Practice Dentistry
19573
TX
Other
Enumeration date
08/23/2006
Last updated
06/13/2024
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