MEDICARE: FERNANDA YANEZ REGONESI DDS, MS

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	10007	KY
2	1223X2210X	Orofacial Pain Dentistry	10007	KY

General Provider Information

NPI Number	:	1730799933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FERNANDA YANEZ REGONESI DDS, MS

Provider Business Mailing Address
First Line	:	740 S LIMESTONE SECOND FLOOR WING C ROOM E214
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40536-0001
Country	:	US
Telephone Number	:	859-323-5500
Fax Number	:

Provider Business Practice Location Address
First Line	:	740 S LIMESTONE SECOND FLOOR WING C ROOM E214
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40536-0001
Country	:	US
Telephone Number	:	859-323-5500
Fax Number	:

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

Provider Enumeration Date	:	08/03/2020
Last Update Date	:	10/05/2020

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