Provider Demographics
NPI:1114080777
Name:BLEVINS, REGINA LYNN (DDS MS)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:LYNN
Last Name:BLEVINS
Suffix:
Gender:F
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 93RD ST E
Mailing Address - Street 2:
Mailing Address - City:INVER GROVE HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55077-4217
Mailing Address - Country:US
Mailing Address - Phone:651-451-3551
Mailing Address - Fax:
Practice Address - Street 1:3100 WOODBURY DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55129-9600
Practice Address - Country:US
Practice Address - Phone:651-714-4987
Practice Address - Fax:651-730-0415
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN102441223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics