Provider Demographics
NPI:1902910540
Name:REAGAN, SHELLIE ALESHA (DDS)
Entity Type:Individual
Prefix:
First Name:SHELLIE
Middle Name:ALESHA
Last Name:REAGAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8419 LOUETTA ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77375
Mailing Address - Country:US
Mailing Address - Phone:281-401-8200
Mailing Address - Fax:281-401-8201
Practice Address - Street 1:8419 LOUETTA RD
Practice Address - Street 2:SUITE A
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-6737
Practice Address - Country:US
Practice Address - Phone:281-401-8200
Practice Address - Fax:281-401-8201
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15755122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX681227OtherUNITED CONCORDIA
TX15755OtherBLUE CROSS BLUE SHIELD