Provider Demographics
NPI:1073175410
Name:SMITH, REAGAN AUSTIN CARL (DDS)
Entity type:Individual
Prefix:
First Name:REAGAN
Middle Name:AUSTIN CARL
Last Name:SMITH
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19702 BELLA LOMA APT 8002
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78256-0008
Mailing Address - Country:US
Mailing Address - Phone:512-289-5597
Mailing Address - Fax:
Practice Address - Street 1:2525 LOUETTA RD STE 100
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-4785
Practice Address - Country:US
Practice Address - Phone:281-350-8852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-06
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX352921223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice