Provider Demographics
NPI:1154745842
Name:REGGIARDO, PAUL ALAN (DDS)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:ALAN
Last Name:REGGIARDO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17742 BEACH BLVD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-6818
Mailing Address - Country:US
Mailing Address - Phone:714-848-0234
Mailing Address - Fax:714-842-0773
Practice Address - Street 1:17742 BEACH BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-6818
Practice Address - Country:US
Practice Address - Phone:714-848-0234
Practice Address - Fax:714-842-0773
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-14
Last Update Date:2014-02-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA205731223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry