Provider Demographics
NPI:1629706742
Name:J. F. REGIS PLLC
Entity Type:Organization
Organization Name:J. F. REGIS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:REGIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-790-0310
Mailing Address - Street 1:36375 HARPER AVE.
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035
Mailing Address - Country:US
Mailing Address - Phone:586-790-0310
Mailing Address - Fax:586-790-9111
Practice Address - Street 1:36375 HARPER AVE.
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48035
Practice Address - Country:US
Practice Address - Phone:586-790-0310
Practice Address - Fax:586-790-9111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty