Healthcare Provider Details

I. General information

NPI: 1437029410
Provider Name (Legal Business Name): REAGAN M WHITELEATHER RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2025
Last Update Date: 11/06/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 W MAIN ST
GREEN RIVER UT
84525-0417
US

IV. Provider business mailing address

PO BOX 417
GREEN RIVER UT
84525-0417
US

V. Phone/Fax

Practice location:
  • Phone: 435-564-3434
  • Fax: 435-564-3214
Mailing address:
  • Phone: 435-564-3434
  • Fax: 435-564-3214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number14239602-9920
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: