Provider Demographics
NPI:1235713447
Name:DASE, REGINA SHAYE (RDH)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:SHAYE
Last Name:DASE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 CHILDERS CIR
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:SC
Mailing Address - Zip Code:29673-7708
Mailing Address - Country:US
Mailing Address - Phone:864-396-3974
Mailing Address - Fax:
Practice Address - Street 1:105 CHILDERS CIR
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:SC
Practice Address - Zip Code:29673-7708
Practice Address - Country:US
Practice Address - Phone:864-396-3974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC46011223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4601OtherDENTAL HYGIENIST