Provider Demographics
NPI:1578661724
Name:NONNENMANN, REGINA MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:REGINA
Middle Name:MARIE
Last Name:NONNENMANN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 NW 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ALEDO
Mailing Address - State:IL
Mailing Address - Zip Code:61231-1404
Mailing Address - Country:US
Mailing Address - Phone:309-582-2405
Mailing Address - Fax:309-582-2400
Practice Address - Street 1:303 NW 2ND ST
Practice Address - Street 2:
Practice Address - City:ALEDO
Practice Address - State:IL
Practice Address - Zip Code:61231-1404
Practice Address - Country:US
Practice Address - Phone:309-582-2405
Practice Address - Fax:309-582-2400
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist