Provider Demographics
NPI:1083066260
Name:REYES, DIANA CAROLINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:CAROLINA
Last Name:REYES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:CAROLINA
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2731 FM 1463 RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-3828
Mailing Address - Country:US
Mailing Address - Phone:281-712-6980
Mailing Address - Fax:
Practice Address - Street 1:2731 FM 1463 RD
Practice Address - Street 2:SUITE 500
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-3828
Practice Address - Country:US
Practice Address - Phone:281-712-6980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX319701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice