Provider Demographics
NPI:1972672764
Name:REGAN, MICHAEL (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:REGAN
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 1:345 COURTHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:HAYESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28904-0020
Mailing Address - Country:US
Mailing Address - Phone:828-389-8052
Mailing Address - Fax:828-389-8533
Practice Address - Street 1:345 COURTHOUSE DR
Practice Address - Street 2:
Practice Address - City:HAYESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28904-0020
Practice Address - Country:US
Practice Address - Phone:828-389-8052
Practice Address - Fax:828-389-8533
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC80741223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5908852Medicaid