Provider Demographics
NPI:1871182964
Name:REGINE DYER DDS,LLC & MATTHEW HENSON DDS, LLC
Entity Type:Organization
Organization Name:REGINE DYER DDS,LLC & MATTHEW HENSON DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSAURYS
Authorized Official - Middle Name:
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-833-3200
Mailing Address - Street 1:2400 VETERANS MEMORIAL BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70062-8723
Mailing Address - Country:US
Mailing Address - Phone:504-833-3200
Mailing Address - Fax:
Practice Address - Street 1:2400 VETERANS MEMORIAL BLVD STE 210
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70062-8723
Practice Address - Country:US
Practice Address - Phone:504-833-3200
Practice Address - Fax:504-833-0183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty