Provider Demographics
NPI:1912916123
Name:ANDREGG, MARK ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALAN
Last Name:ANDREGG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:10125 S SHERIDAN RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-6737
Mailing Address - Country:US
Mailing Address - Phone:918-296-3006
Mailing Address - Fax:918-296-3070
Practice Address - Street 1:10125 S SHERIDAN RD
Practice Address - Street 2:SUITE E
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-6737
Practice Address - Country:US
Practice Address - Phone:918-296-3006
Practice Address - Fax:918-296-3070
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK50991223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics