Provider Demographics
NPI:1649303397
Name:REAGAN, WILLIAM RONEU (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:RONEU
Last Name:REAGAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 FOREST SQ
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-4463
Mailing Address - Country:US
Mailing Address - Phone:903-758-4431
Mailing Address - Fax:903-753-5458
Practice Address - Street 1:444 FOREST SQ
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-4463
Practice Address - Country:US
Practice Address - Phone:903-758-4431
Practice Address - Fax:903-753-5458
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX91091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB09109-1OtherCHIP PROVIDER #
TX9109OtherLISCENCE #