Provider Demographics
NPI:1730483587
Name:REGAN, MAI LINH T (DMD)
Entity Type:Individual
Prefix:DR
First Name:MAI LINH
Middle Name:T
Last Name:REGAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51208 RADCLIFFE CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46637-6046
Mailing Address - Country:US
Mailing Address - Phone:617-504-8718
Mailing Address - Fax:
Practice Address - Street 1:3560 ELKHART RD
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-5814
Practice Address - Country:US
Practice Address - Phone:574-875-7711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-07
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013660A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist