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General NPI Number Information
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NPI Number | 1538612296
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Entity Type | Organization
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Legal Business Name | JEFFREY C. REGELIN
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Dates
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Enumeration Date | 07/29/2016
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Last Update Date | 07/29/2016
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Provider Practice Location Address
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Address Line | 902 W 14TH AVE
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City | SPOKANE
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State | WA
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Zip | 99204-3822
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Country | US
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Telephone | 509-838-4137
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Fax | 509-838-2737
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Provider Business Mailing Address
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Address Line | 902 W 14TH AVE
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City | SPOKANE
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State | WA
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Zip | 99204-3822
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Country | US
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Telephone | 509-838-4137
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Fax | 509-838-2737
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CATHY FRANCES KOEGEN
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Credential |
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Telephone | 509-838-4137
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 60028773
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License Number State | WA
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