MEDICARE: DR. WILLIAM MARK REGENOLD D.D.S.

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	DS0000008750	TN

General Provider Information

NPI Number	:	1487839585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM MARK REGENOLD D.D.S.

Provider Business Mailing Address
First Line	:	4825 MAIN ST
Second Line	:	SUITE 10
City	:	SPRING HILL
State	:	TN
Zip	:	37174-2768
Country	:	US
Telephone Number	:	615-614-2201
Fax Number	:

Provider Business Practice Location Address
First Line	:	4825 MAIN ST
Second Line	:	SUITE 10
City	:	SPRING HILL
State	:	TN
Zip	:	37174-2768
Country	:	US
Telephone Number	:	615-614-2201
Fax Number	:

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

Provider Enumeration Date	:	01/08/2008
Last Update Date	:	05/10/2013

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