Provider Demographics
NPI:1942305610
Name:REGELIN, JEFFREY CHARLES (DMD)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:CHARLES
Last Name:REGELIN
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 1:902 W 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-3822
Mailing Address - Country:US
Mailing Address - Phone:509-838-4137
Mailing Address - Fax:
Practice Address - Street 1:902 W 14TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-3822
Practice Address - Country:US
Practice Address - Phone:509-838-4137
Practice Address - Fax:509-838-2737
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD40121223G0001X
WA60028773122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist