Provider Demographics
NPI:1669541470
Name:REGULA, CHESTER JOHN JR (DMD)
Entity type:Individual
Prefix:DR
First Name:CHESTER
Middle Name:JOHN
Last Name:REGULA
Suffix:JR
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 1:38000 ANN ARBOR TRL
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-2453
Mailing Address - Country:US
Mailing Address - Phone:734-591-3636
Mailing Address - Fax:734-591-3355
Practice Address - Street 1:38000 ANN ARBOR TRL
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-2453
Practice Address - Country:US
Practice Address - Phone:734-591-3636
Practice Address - Fax:734-591-3355
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010120931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2901012093OtherLICENSE NUMBER