Renata K Regalado, DMD

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

Practice address

4218 South State Route 159
Suite 1
Glen Carbon, IL 62034

Phone

(618) 288-7000

NPI assigned

Dec 20, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1376607812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 BAYFIELD DRIVE",
            "city": "GLEN CARBON",
            "state": "IL",
            "postal_code": "62034",
            "telephone_number": "618-288-4469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4218 SOUTH STATE ROUTE 159",
            "address_2": "SUITE 1",
            "city": "GLEN CARBON",
            "state": "IL",
            "postal_code": "62034",
            "telephone_number": "618-288-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REGALADO",
        "first_name": "RENATA",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Orthodontics and Dentofacial Orthopedics Dentistry in Glen Carbon, IL
• Providers in Glen Carbon, IL by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.