Individual
DAVID L REAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
11401 HEACOCK ST, SUITE 320, MORENO VALLEY, CA 92557-7908
(951) 247-7040
(951) 247-5092
Mailing address
11401 HEACOCK ST, SUITE 320, MORENO VALLEY, CA 92557-7908
(951) 247-7040
(951) 247-5092
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
32166
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G90361-01
DENTICAL
CA
Enumeration date
08/01/2008
Last updated
08/01/2008
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