Provider Demographics
NPI:1467801365
Name:POWE, REGINA (DSD)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:POWE
Suffix:
Gender:F
Credentials:DSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 INDEPENDENCE PKWY
Mailing Address - Street 2:SUITE107
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-5463
Mailing Address - Country:US
Mailing Address - Phone:972-612-9948
Mailing Address - Fax:
Practice Address - Street 1:5501 INDEPENDENCE PKWY
Practice Address - Street 2:SUITE107
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-5463
Practice Address - Country:US
Practice Address - Phone:972-612-9948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-10
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX164501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice