MEDICARE: DR. MICHAEL C REGAN DMD

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	122300000X	Dentist	6536	OR

General Provider Information

NPI Number	:	1629069018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL C REGAN DMD

Provider Business Mailing Address
First Line	:	6969 SE LAKE RD
Second Line	:
City	:	MILWAUKIE
State	:	OR
Zip	:	97267-2103
Country	:	US
Telephone Number	:	503-654-8283
Fax Number	:	503-659-5210

Provider Business Practice Location Address
First Line	:	6969 SE LAKE RD
Second Line	:
City	:	MILWAUKIE
State	:	OR
Zip	:	97267-2103
Country	:	US
Telephone Number	:	503-654-8283
Fax Number	:	503-659-5210

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

Provider Enumeration Date	:	11/03/2005
Last Update Date	:	02/01/2021

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