MEDICARE: EDUARDO G REGALADO JR. DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	107660	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477618783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDUARDO G REGALADO JR. DDS

Provider Business Mailing Address
First Line	:	3912 18 MILE
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48314
Country	:	US
Telephone Number	:	586-264-3200
Fax Number	:	586-264-3241

Provider Business Practice Location Address
First Line	:	3912 18 MILE
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48314
Country	:	US
Telephone Number	:	586-264-3200
Fax Number	:	586-264-3241

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	07/08/2007

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