Provider Demographics
NPI:1629069018
Name:REGAN, MICHAEL C (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:C
Last Name:REGAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6969 SE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97267-2103
Mailing Address - Country:US
Mailing Address - Phone:503-654-8283
Mailing Address - Fax:503-659-5210
Practice Address - Street 1:6969 SE LAKE RD
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97267-2103
Practice Address - Country:US
Practice Address - Phone:503-654-8283
Practice Address - Fax:503-659-5210
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6536122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist