Provider Demographics
NPI:1780769158
Name:DREGALLA, CHRISTINE (DDS)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:DREGALLA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 MAIN ST
Mailing Address - Street 2:PO BOX 146
Mailing Address - City:PENDER
Mailing Address - State:NE
Mailing Address - Zip Code:68047
Mailing Address - Country:US
Mailing Address - Phone:402-385-3188
Mailing Address - Fax:402-385-0165
Practice Address - Street 1:402 MAIN ST
Practice Address - Street 2:
Practice Address - City:PENDER
Practice Address - State:NE
Practice Address - Zip Code:68047
Practice Address - Country:US
Practice Address - Phone:402-385-3188
Practice Address - Fax:402-385-0165
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE66291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025402600Medicaid