Provider Demographics
NPI:1356586234
Name:NIEKRASH, REGINA A (DMD)
Entity type:Individual
Prefix:DR
First Name:REGINA
Middle Name:A
Last Name:NIEKRASH
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 1:65 ANDERSON ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-2537
Mailing Address - Country:US
Mailing Address - Phone:203-777-8436
Mailing Address - Fax:
Practice Address - Street 1:65 ANDERSON ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-2537
Practice Address - Country:US
Practice Address - Phone:203-777-8436
Practice Address - Fax:203-777-8437
Is Sole Proprietor?:No
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0073391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice