Provider Demographics
NPI:1316438120
Name:REGAN, CHRISTINA LYNN (DMD)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:LYNN
Last Name:REGAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:LYNN
Other - Last Name:LEPOCHAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:13254 STATE ROAD 54
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-3483
Mailing Address - Country:US
Mailing Address - Phone:813-448-6885
Mailing Address - Fax:813-448-6886
Practice Address - Street 1:13254 STATE ROAD 54
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-3483
Practice Address - Country:US
Practice Address - Phone:813-448-6885
Practice Address - Fax:813-448-6886
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1857952122300000X
FLDN23658122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist