Provider Demographics
NPI:1083343586
Name:REGENCY FAMILY DENTAL
Entity type:Organization
Organization Name:REGENCY FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL HYGIENIST/OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:CHRISTI
Authorized Official - Last Name:KAYSER
Authorized Official - Suffix:
Authorized Official - Credentials:RDH BS
Authorized Official - Phone:248-601-6320
Mailing Address - Street 1:54826 DEQUINDRE RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-5625
Mailing Address - Country:US
Mailing Address - Phone:248-601-6320
Mailing Address - Fax:248-601-4416
Practice Address - Street 1:54826 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48316-5625
Practice Address - Country:US
Practice Address - Phone:248-601-6320
Practice Address - Fax:248-601-4416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2901015191OtherSTATE DENTAL LICENSE