Provider Demographics
NPI:1558602169
Name:REGE, SUBHASH G (MDS)
Entity Type:Individual
Prefix:
First Name:SUBHASH
Middle Name:G
Last Name:REGE
Suffix:
Gender:M
Credentials:MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1764 PALM BAY RD NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-2904
Mailing Address - Country:US
Mailing Address - Phone:321-725-5512
Mailing Address - Fax:321-725-5592
Practice Address - Street 1:1764 PALM BAY RD NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-2904
Practice Address - Country:US
Practice Address - Phone:321-725-5512
Practice Address - Fax:321-725-5592
Is Sole Proprietor?:No
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL111481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice