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General NPI Number Information
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NPI Number | 1487826632
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Entity Type | Organization
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Legal Business Name | REGO DENTAL, LLP
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Dates
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Enumeration Date | 03/27/2008
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Last Update Date | 06/12/2008
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Provider Practice Location Address
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Address Line | 13620 38TH AVE SUITE 6C
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City | FLUSHING
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State | NY
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Zip | 11354-4233
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Country | US
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Telephone | 718-886-8199
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Fax | 718-886-8699
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Provider Business Mailing Address
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Address Line | 13620 38TH AVE SUITE 6C
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City | FLUSHING
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State | NY
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Zip | 11354-4233
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Country | US
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Telephone | 718-886-8199
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Fax | 718-886-8699
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Authorized Official
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Title or Position | ORAL SURGEON
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Name | DR. KEVIN X XUE
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Credential | DMD
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Telephone | 917-817-5460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 043904
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 046816
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License Number State | NY
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