Provider Demographics
NPI:1225294127
Name:REYES, REBECCA TRINIDAD (DMD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:TRINIDAD
Last Name:REYES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:REBECCA
Other - Middle Name:T REYES
Other - Last Name:MORROW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:2017 GREENBAY ROAD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60064
Mailing Address - Country:US
Mailing Address - Phone:847-689-1213
Mailing Address - Fax:847-689-1969
Practice Address - Street 1:2017 GREENBAY RD
Practice Address - Street 2:
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064
Practice Address - Country:US
Practice Address - Phone:847-689-1213
Practice Address - Fax:847-689-1969
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019021443122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist