Provider Demographics
NPI:1508260233
Name:REGEHR, BRYDAN DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRYDAN
Middle Name:DAVID
Last Name:REGEHR
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 1:189 ACADEMY ST APT 5
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-3188
Mailing Address - Country:US
Mailing Address - Phone:415-359-4416
Mailing Address - Fax:
Practice Address - Street 1:179 ACADEMY ST
Practice Address - Street 2:
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-3103
Practice Address - Country:US
Practice Address - Phone:207-764-3764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN44011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice