MEDICARE: DAVID W. REGIANI, DDS, PC

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	11926	MI

General Provider Information

NPI Number	:	1962471631
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID W. REGIANI, DDS, PC

Provider Business Mailing Address
First Line	:	10435 ORTONVILLE ROAD - SUITE B
Second Line	:
City	:	CLARKSTON
State	:	MI
Zip	:	48348
Country	:	US
Telephone Number	:	248-625-5222
Fax Number	:	248-922-7808

Provider Business Practice Location Address
First Line	:	10435 ORTONVILLE ROAD - SUITE B
Second Line	:
City	:	CLARKSTON
State	:	MI
Zip	:	48348
Country	:	US
Telephone Number	:	248-625-5222
Fax Number	:	248-922-7808

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	DR. DAVID WILLIAM REGIANI
Credential	:	D.D.S.
Telephone Number	:	248-625-5222

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	09/28/2016

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