Provider Demographics
NPI:1467446252
Name:DANDAR, REGIS ALLEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:REGIS
Middle Name:ALLEN
Last Name:DANDAR
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 1:217 S POINDEXTER ST
Mailing Address - Street 2:PO BOX 1736
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27906-1736
Mailing Address - Country:US
Mailing Address - Phone:252-335-4421
Mailing Address - Fax:252-264-5465
Practice Address - Street 1:217 S POINDEXTER ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-4834
Practice Address - Country:US
Practice Address - Phone:252-335-4421
Practice Address - Fax:252-264-5465
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8991974Medicaid