Provider Demographics
NPI:1861431306
Name:REAGAN, STEPHEN EARL (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:EARL
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:UNIVERSITY OF OKLAHOMA COLLEGE OF DENTISTRY
Mailing Address - Street 2:1201 N. STONEWALL AVE., ROOM 305
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73190-0001
Mailing Address - Country:US
Mailing Address - Phone:405-271-5222
Mailing Address - Fax:405-271-3851
Practice Address - Street 1:UNIVERSITY OF OKLAHOMA COLLEGE OF DENTISTRY
Practice Address - Street 2:1201 N. STONEWALL AVE., ROOM 305
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73190-0001
Practice Address - Country:US
Practice Address - Phone:405-271-5222
Practice Address - Fax:405-271-3851
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK38601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice