1770816621 NPI number — STEVEN L. REGAN D.D.S., PLLC

Table of content: (NPI 1770816621)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770816621 NPI number — STEVEN L. REGAN D.D.S., PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEVEN L. REGAN D.D.S., PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770816621
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1354 DOMINION OAKS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHINA SPRING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76633-3108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-836-9485
Provider Business Mailing Address Fax Number:
254-675-6505

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 S AVENUE T
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLIFTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76634-1833
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-675-8301
Provider Business Practice Location Address Fax Number:
254-675-6505
Provider Enumeration Date:
09/10/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
REGAN
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
254-675-8301

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)