Organization
DDE LLC
Active
Other names
Advanced Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TERRY R EGAN DDS (MEMBER)
(314) 739-3300
Entity
Organization
Contact information
Practice address
12758 BOENKER LN, BRIDGETON, MO 63044-2436
(314) 739-3300
Mailing address
12758 BOENKER LN, BRIDGETON, MO 63044-2436
(314) 739-3300
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
MO
Other
Enumeration date
03/20/2007
Last updated
08/22/2020
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