Provider Demographics
NPI:1467539163
Name:MACKIEWICZ DAILEY, REGINA (DMD)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:MACKIEWICZ DAILEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:
Other - Last Name:DAILEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:221 N INGALLS ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-1511
Mailing Address - Country:US
Mailing Address - Phone:734-996-0055
Mailing Address - Fax:734-996-5934
Practice Address - Street 1:221 N INGALLS ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-1511
Practice Address - Country:US
Practice Address - Phone:734-996-0055
Practice Address - Fax:734-996-5934
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI144951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice