Provider Demographics
NPI:1699795070
Name:REGAN, JOHN E (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:E
Last Name:REGAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:46750-2033
Mailing Address - Country:US
Mailing Address - Phone:260-356-6119
Mailing Address - Fax:260-356-8426
Practice Address - Street 1:650 CHERRY ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:IN
Practice Address - Zip Code:46750-2033
Practice Address - Country:US
Practice Address - Phone:260-356-6119
Practice Address - Fax:260-356-8426
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120058261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice