Provider Demographics
NPI:1487839585
Name:REGENOLD, WILLIAM MARK (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:MARK
Last Name:REGENOLD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4825 MAIN ST
Mailing Address - Street 2:SUITE 10
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-2768
Mailing Address - Country:US
Mailing Address - Phone:615-614-2201
Mailing Address - Fax:
Practice Address - Street 1:4825 MAIN ST
Practice Address - Street 2:SUITE 10
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-2768
Practice Address - Country:US
Practice Address - Phone:615-614-2201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000087501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice