Healthcare Provider Details

I. General information

NPI: 1962471631
Provider Name (Legal Business Name): DAVID W. REGIANI, DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 09/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10435 ORTONVILLE ROAD - SUITE B
CLARKSTON MI
48348
US

IV. Provider business mailing address

10435 ORTONVILLE ROAD - SUITE B
CLARKSTON MI
48348
US

V. Phone/Fax

Practice location:
  • Phone: 248-625-5222
  • Fax: 248-922-7808
Mailing address:
  • Phone: 248-625-5222
  • Fax: 248-922-7808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number11926
License Number StateMI

VIII. Authorized Official

Name: DR. DAVID WILLIAM REGIANI
Title or Position: OWNER/DENTIST
Credential: D.D.S.
Phone: 248-625-5222