1821635285 NPI number — REGENTS DENTAL GROUP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821635285 NPI number — REGENTS DENTAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REGENTS DENTAL GROUP
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:
1821635285
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4150 REGENTS PARK ROW
Provider Second Line Business Mailing Address:
SUITE 215
Provider Business Mailing Address City Name:
LA JOLLA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92037
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-587-9077
Provider Business Mailing Address Fax Number:
858-587-4663

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4150 REGENTS PARK ROW
Provider Second Line Business Practice Location Address:
SUITE 215
Provider Business Practice Location Address City Name:
LA JOLLA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-587-9077
Provider Business Practice Location Address Fax Number:
858-587-4663
Provider Enumeration Date:
12/04/2019

Additional Information

Authorized Official

Authorized Official Last Name:
LOCKWOOD
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
EVERETT
Authorized Official Title or Position:
BUSINESS PARTNER/DENTIST
Authorized Official Telephone Number:
858-587-9077

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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