Provider Demographics
NPI:1902392715
Name:REAGAN, ZACHARY K (DMD)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:K
Last Name:REAGAN
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 1:399 STEVENS AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-2608
Mailing Address - Country:US
Mailing Address - Phone:207-423-2674
Mailing Address - Fax:
Practice Address - Street 1:440 NARRAGANSETT TRL
Practice Address - Street 2:
Practice Address - City:BUXTON
Practice Address - State:ME
Practice Address - Zip Code:04093-6505
Practice Address - Country:US
Practice Address - Phone:207-929-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-04
Last Update Date:2018-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN46391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice