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NPI Code Detail

MEDICARE: REAGAN AUSTIN CARL SMITH DDS

MEDICARE: REAGAN AUSTIN CARL SMITH 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 Dentistry35292TX
2122300000XDentist35292TX

General Provider Information

NPI Number : 1073175410
Entity Type Code : Individual
Provider Name (Legal Business Name) : REAGAN AUSTIN CARL SMITH DDS
Provider Business Mailing Address
First Line : 19702 BELLA LOMA APT 8002
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78256-0008
Country : US
Telephone Number : 512-289-5597
Fax Number :
Provider Business Practice Location Address
First Line : 2525 LOUETTA RD STE 100
Second Line :
City : SPRING
State : TX
Zip : 77388-4785
Country : US
Telephone Number : 281-350-8852
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2019
Last Update Date : 03/26/2025

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Directions to “ REAGAN AUSTIN CARL SMITH DDS” Practice Location

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