Provider Demographics
NPI:1932602828
Name:MUSHEYEV, REGINA (DDS)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:MUSHEYEV
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:REGINA
Other - Middle Name:
Other - Last Name:MUSHEYEV
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:108-11 66TH
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375
Mailing Address - Country:US
Mailing Address - Phone:646-899-4343
Mailing Address - Fax:
Practice Address - Street 1:108-11 66TH
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:646-899-4343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-16
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055125-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice