Provider Demographics
NPI:1053441600
Name:REYES, RUBY CHAO (DDS)
Entity Type:Individual
Prefix:DR
First Name:RUBY
Middle Name:CHAO
Last Name:REYES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:RUBI
Other - Middle Name:CHAO
Other - Last Name:REYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9225 MIRA MESA BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-4810
Mailing Address - Country:US
Mailing Address - Phone:619-536-9383
Mailing Address - Fax:619-536-9395
Practice Address - Street 1:9225 MIRA MESA BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4810
Practice Address - Country:US
Practice Address - Phone:619-536-9383
Practice Address - Fax:619-536-9395
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39875122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist