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NPI Code Detail

MEDICARE: DR. SCOTTIE REAGAN II DDS

MEDICARE: DR. SCOTTIE REAGAN II DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry11994TN

General Provider Information

NPI Number : 1023743119
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SCOTTIE REAGAN II DDS
Provider Business Mailing Address
First Line : 245 MIDWAY MEDICAL PARK
Second Line :
City : BRISTOL
State : TN
Zip : 37620-1653
Country : US
Telephone Number : 423-652-0260
Fax Number :
Provider Business Practice Location Address
First Line : 245 MIDWAY MEDICAL PARK
Second Line :
City : BRISTOL
State : TN
Zip : 37620-1653
Country : US
Telephone Number : 423-652-0260
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2022
Last Update Date : 07/21/2022

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Directions to “ DR. SCOTTIE REAGAN II DDS” Practice Location

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