Provider Demographics
NPI:1376762617
Name:REGAN, THOMAS LEWIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:LEWIS
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 1:211 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:QUARRYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17566-1122
Mailing Address - Country:US
Mailing Address - Phone:717-786-3104
Mailing Address - Fax:717-786-2653
Practice Address - Street 1:211 W 4TH ST
Practice Address - Street 2:
Practice Address - City:QUARRYVILLE
Practice Address - State:PA
Practice Address - Zip Code:17566-1122
Practice Address - Country:US
Practice Address - Phone:717-786-3104
Practice Address - Fax:717-786-2653
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS02073L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice