Provider Demographics
NPI:1306859715
Name:FARIS, REYNA LEE (BS RDH)
Entity Type:Individual
Prefix:MRS
First Name:REYNA
Middle Name:LEE
Last Name:FARIS
Suffix:
Gender:F
Credentials:BS RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 660
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NC
Mailing Address - Zip Code:27569
Mailing Address - Country:US
Mailing Address - Phone:919-936-2418
Mailing Address - Fax:919-936-2789
Practice Address - Street 1:104 CENTER ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NC
Practice Address - Zip Code:27569
Practice Address - Country:US
Practice Address - Phone:919-936-2418
Practice Address - Fax:919-936-2789
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7756124Q00000X
TX10935124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist