Provider Demographics
NPI:1306404066
Name:REYES, LILIAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:LILIAN
Middle Name:
Last Name:REYES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6426 BROOK VILLAGE CV # 1312
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34202-2718
Mailing Address - Country:US
Mailing Address - Phone:786-216-8021
Mailing Address - Fax:
Practice Address - Street 1:5231 UNIVERSITY PKWY UNIT 120
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PARK
Practice Address - State:FL
Practice Address - Zip Code:34201-3009
Practice Address - Country:US
Practice Address - Phone:941-363-0458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18583341223G0001X
FLDN246541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice