Provider Demographics
NPI:1437248085
Name:MCGRATH, REGINA MARY (DDS)
Entity Type:Individual
Prefix:DR
First Name:REGINA
Middle Name:MARY
Last Name:MCGRATH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 CITY WEST PKWY
Mailing Address - Street 2:#315
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344
Mailing Address - Country:US
Mailing Address - Phone:952-941-9829
Mailing Address - Fax:
Practice Address - Street 1:6600 CITY WEST PKWY
Practice Address - Street 2:#315
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-3261
Practice Address - Country:US
Practice Address - Phone:952-941-9829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND10452122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist