Provider Demographics
NPI:1962471631
Name:DAVID W. REGIANI, DDS, PC
Entity Type:Organization
Organization Name:DAVID W. REGIANI, DDS, PC
Other - Org Name:REGIANI HOLISTIC DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:REGIANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-625-5222
Mailing Address - Street 1:10435 ORTONVILLE ROAD - SUITE B
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48348
Mailing Address - Country:US
Mailing Address - Phone:248-625-5222
Mailing Address - Fax:248-922-7808
Practice Address - Street 1:10435 ORTONVILLE ROAD - SUITE B
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48348
Practice Address - Country:US
Practice Address - Phone:248-625-5222
Practice Address - Fax:248-922-7808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI11926122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty