Individual
JEFFERY GLEN REAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
311 W 43RD ST, SUITE 1405, NEW YORK, NY 10036-6413
(212) 581-5050
Mailing address
311 W 43RD ST, SUITE 1405, NEW YORK, NY 10036-6413
(212) 581-5050
Taxonomy
Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
Primary
047451
NY
Other
Enumeration date
06/10/2009
Last updated
09/22/2010
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