Healthcare Provider Details

I. General information

NPI: 1487826632
Provider Name (Legal Business Name): REGO DENTAL, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13620 38TH AVE SUITE 6C
FLUSHING NY
11354-4233
US

IV. Provider business mailing address

13620 38TH AVE SUITE 6C
FLUSHING NY
11354-4233
US

V. Phone/Fax

Practice location:
  • Phone: 718-886-8199
  • Fax: 718-886-8699
Mailing address:
  • Phone: 718-886-8199
  • Fax: 718-886-8699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number046816
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number043904
License Number StateNY

VIII. Authorized Official

Name: DR. KEVIN X XUE
Title or Position: ORAL SURGEON
Credential: DMD
Phone: 917-817-5460