NPIMap

Organization Active NPI

David Reagan & Robert Smith DDS Smith Robert F Gen PTR.

  • General Practice Dentistry
  • Moreno Valley, CA
National Provider Identifier
1669540084
Registry record updated Jan 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DH32166 Issued in CA
Legal business name
DAVID REAGAN & ROBERT SMITH DDS SMITH ROBERT F GEN PTR.
Doing business as
North Heacock Dental Group
Practice address
11401 Heacock St
Suite 320
Moreno Valley, CA 92557-9998
Phone
(951) 247-7040
Fax
(951) 247-5092
NPI assigned
Dec 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. David L Reagan, DDSNPI 1467618199
Title
Owner/Partner
Phone
(951) 247-7040

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X DH32166 CA Primary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X DB31029 CA

Addresses

Primary practice location

11401 Heacock St
Suite 320
Moreno Valley, CA 92557-9998

Mailing address

11401 Heacock St
Suite 320
Moreno Valley, CA 92557-9998
Phone (951) 247-7040

Other names 1

  • North Heacock Dental Group Doing business as

National Provider Directory

National Provider Directory

Locations

11401 Heacock St
Ste 320
Moreno Valley, CA 92557
Phone (951) 247-7040

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579478400000",
    "number": "1669540084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11401 HEACOCK ST",
            "address_2": "SUITE 320",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925579998",
            "telephone_number": "951-247-7040",
            "fax_number": "951-247-5092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11401 HEACOCK ST",
            "address_2": "SUITE 320",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925579998",
            "telephone_number": "951-247-7040",
            "fax_number": "951-247-5092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID REAGAN & ROBERT SMITH DDS SMITH ROBERT F GEN PTR.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-01",
        "last_updated": "2020-01-20",
        "certification_date": "2020-01-20",
        "status": "A",
        "authorized_official_last_name": "REAGAN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER/PARTNER",
        "authorized_official_telephone_number": "951-247-7040",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "DH32166",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "DB31029",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Heacock Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Moreno Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.