Provider Demographics
NPI:1871500538
Name:MORTLAND, REGINA CHRISTMAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:REGINA
Middle Name:CHRISTMAN
Last Name:MORTLAND
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 1:10 ENTERPRISE ST
Mailing Address - Street 2:
Mailing Address - City:DUXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02332-3315
Mailing Address - Country:US
Mailing Address - Phone:781-934-2120
Mailing Address - Fax:
Practice Address - Street 1:10 ENTERPRISE ST
Practice Address - Street 2:
Practice Address - City:DUXBURY
Practice Address - State:MA
Practice Address - Zip Code:02332-3315
Practice Address - Country:US
Practice Address - Phone:781-934-2120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA172001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice