MEDICARE: DR. REGAN MACKINTOSH 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	08412	IA

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	:	1619068608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REGAN MACKINTOSH D.D.S.

Provider Business Mailing Address
First Line	:	4920 SOUTH 30TH STREET
Second Line	:	SUITE 103
City	:	OMAHA
State	:	NE
Zip	:	68107-1656
Country	:	US
Telephone Number	:	402-932-7204
Fax Number	:	402-952-1020

Provider Business Practice Location Address
First Line	:	4920 SOUTH 30TH STREET
Second Line	:	SUITE 103
City	:	OMAHA
State	:	NE
Zip	:	68107-1656
Country	:	US
Telephone Number	:	402-932-7204
Fax Number	:	402-952-1020

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

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	01/29/2016

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