Provider Demographics
NPI:1811555006
Name:REGAN, DANIEL (DMD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
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 1:3 TROUT BROOK LN
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1236
Mailing Address - Country:US
Mailing Address - Phone:781-724-3991
Mailing Address - Fax:
Practice Address - Street 1:3 TROUT BROOK LN
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1236
Practice Address - Country:US
Practice Address - Phone:781-724-3991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-03
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18583701223X0400X
IL0210031251223X0400X
390200000X
IL0190333601223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program