Provider Demographics
NPI:1245386598
Name:REYES, ROSEMARIE CRISTINA PATRICIO (DDS)
Entity Type:Individual
Prefix:
First Name:ROSEMARIE CRISTINA
Middle Name:PATRICIO
Last Name:REYES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14357 7TH ST
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-4209
Mailing Address - Country:US
Mailing Address - Phone:760-951-9181
Mailing Address - Fax:888-502-0695
Practice Address - Street 1:14357 7TH ST
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-4209
Practice Address - Country:US
Practice Address - Phone:760-951-9181
Practice Address - Fax:888-502-0695
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA416711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice