Provider Demographics
NPI:1487826632
Name:REGO DENTAL, LLP
Entity Type:Organization
Organization Name:REGO DENTAL, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:X
Authorized Official - Last Name:XUE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:917-817-5460
Mailing Address - Street 1:13620 38TH AVE
Mailing Address - Street 2:SUITE 6C
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4233
Mailing Address - Country:US
Mailing Address - Phone:718-886-8199
Mailing Address - Fax:718-886-8699
Practice Address - Street 1:13620 38TH AVE
Practice Address - Street 2:SUITE 6C
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4233
Practice Address - Country:US
Practice Address - Phone:718-886-8199
Practice Address - Fax:718-886-8699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046816122300000X
NY0439041223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01702010Medicaid