Provider Demographics
NPI:1821688128
Name:REGELSON, SPENCER DYLAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:DYLAN
Last Name:REGELSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 FORBES AVENUE
Mailing Address - Street 2:FORBES TOWER - PLAZA LEVEL SUITE 140
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213
Mailing Address - Country:US
Mailing Address - Phone:412-647-5815
Mailing Address - Fax:
Practice Address - Street 1:3501 TERRACE STREET
Practice Address - Street 2:G-32 SALK HALL
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15261
Practice Address - Country:US
Practice Address - Phone:412-648-8604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-20
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019033092122300000X
PADS043556122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL019033092OtherILLINOIS LICENSE
IL319022454OtherILLINOIS CONTROLLED SUBSTANCE LICENSE
PADS043556OtherPENNSYLVANIA DENTAL LICENSE