Provider Demographics
NPI:1033313564
Name:SANDRA G REYES, DDS. PLLC
Entity Type:Organization
Organization Name:SANDRA G REYES, DDS. PLLC
Other - Org Name:SANDRA REYES, DDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:GARZA
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-654-1811
Mailing Address - Street 1:4854 E BASELINE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4636
Mailing Address - Country:US
Mailing Address - Phone:480-654-1811
Mailing Address - Fax:480-654-1040
Practice Address - Street 1:4854 E BASELINE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4636
Practice Address - Country:US
Practice Address - Phone:480-654-1811
Practice Address - Fax:480-654-1040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ57161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty