Provider Demographics
NPI:1144606286
Name:REYES, MONICA
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:REYES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 NE MULTNOMAH ST STE 850
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-4108
Mailing Address - Country:US
Mailing Address - Phone:503-230-8814
Mailing Address - Fax:503-233-2264
Practice Address - Street 1:700 NE MULTNOMAH ST STE 850
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-4108
Practice Address - Country:US
Practice Address - Phone:503-230-8814
Practice Address - Fax:503-233-2264
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH6192124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist