Provider Demographics
NPI:1316311335
Name:REGNI, GERALD JOSEPH JR (DMD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:JOSEPH
Last Name:REGNI
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:937 CHRISTIAN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-3832
Mailing Address - Country:US
Mailing Address - Phone:215-351-9399
Mailing Address - Fax:
Practice Address - Street 1:937 CHRISTIAN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-3832
Practice Address - Country:US
Practice Address - Phone:215-351-9399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-16
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-025274L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist