Basic Information
| Provider Information | |||||||||
| NPI: | 1881321610 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MINOGUE | ||||||||
| FirstName: | REGINA | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CRDH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8630 TENBRIDGE WAY | ||||||||
| Address2: | |||||||||
| City: | NEW PORT RICHEY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346544693 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8133402468 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 702 JASMINE WAY | ||||||||
| Address2: | |||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337564086 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278248181 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2022 | ||||||||
| LastUpdateDate: | 08/02/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 124Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dental Hygienist |
No ID Information.