Provider Demographics
NPI:1194934869
Name:ROBERT J DEREGIS DMD,PC
Entity type:Organization
Organization Name:ROBERT J DEREGIS DMD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEREGIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-862-7474
Mailing Address - Street 1:183 BEDFORD ST STE 1
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-4428
Mailing Address - Country:US
Mailing Address - Phone:781-862-7474
Mailing Address - Fax:781-862-7475
Practice Address - Street 1:183 BEDFORD ST STE 1
Practice Address - Street 2:SUITE 1
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-4428
Practice Address - Country:US
Practice Address - Phone:781-862-7474
Practice Address - Fax:781-862-7475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA186261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty