Provider Demographics
NPI:1992778054
Name:REGENYE, GLENN R (DMD)
Entity type:Individual
Prefix:MR
First Name:GLENN
Middle Name:R
Last Name:REGENYE
Suffix:
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 1:619 AMBOY AVE
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-3553
Mailing Address - Country:US
Mailing Address - Phone:732-738-6555
Mailing Address - Fax:732-738-6565
Practice Address - Street 1:619 AMBOY AVE
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-3553
Practice Address - Country:US
Practice Address - Phone:732-738-6555
Practice Address - Fax:732-738-6565
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ151481223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJRE421715Medicare ID - Type Unspecified