| Regency Square Dental | |
|
4789 Sw 148th Ave Suite #205 Davie FL 33330-2119 | |
| (954) 252-5911 | |
| (954) 434-8075 |
| Full Name | Regency Square Dental |
|---|---|
| Speciality | Dentist |
| Location | 4789 Sw 148th Ave, Davie, Florida |
| Authorized Official Name and Position | Reinol Antonio Gonzalez (PRESIDENT) |
| Authorized Official Contact | 9542525911 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Regency Square Dental 4789 Sw 148th Ave Suite #205 Davie FL 33330-2119 Ph: (954) 252-5911 | Regency Square Dental 4789 Sw 148th Ave Suite #205 Davie FL 33330-2119 Ph: (954) 252-5911 |
| NPI Number | 1700949682 |
|---|---|
| Provider Enumeration Date | 12/19/2006 |
| Last Update Date | 04/30/2024 |
| Certification Date | 04/30/2024 |
| Medicare PECOS PAC ID | 2466878962 |
|---|---|
| Medicare Enrollment ID | O20200814000328 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700949682 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | () | Primary |
| Provider Name | Reinol Antonio Gonzalez |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1093878043 PECOS PAC ID: 3375969876 Enrollment ID: I20200814000364 |
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