Healthcare Provider Details

I. General information

NPI: 1629069018
Provider Name (Legal Business Name): MICHAEL C REGAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6969 SE LAKE RD
MILWAUKIE OR
97267-2103
US

IV. Provider business mailing address

6969 SE LAKE RD
MILWAUKIE OR
97267-2103
US

V. Phone/Fax

Practice location:
  • Phone: 503-654-8283
  • Fax: 503-659-5210
Mailing address:
  • Phone: 503-654-8283
  • Fax: 503-659-5210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6536
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: