Provider Demographics
NPI:1598825168
Name:KOENIG, REGINA M (DMD)
Entity type:Individual
Prefix:DR
First Name:REGINA
Middle Name:M
Last Name:KOENIG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 THAMES BLVD
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-3911
Mailing Address - Country:US
Mailing Address - Phone:718-920-2303
Mailing Address - Fax:718-798-9835
Practice Address - Street 1:3444 KOSSUTH AVE
Practice Address - Street 2:DTC/ SCHIFF PAVILION
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2410
Practice Address - Country:US
Practice Address - Phone:718-920-2303
Practice Address - Fax:718-547-7105
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043333122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist