Provider Demographics
NPI:1366858896
Name:EMELITO R. REYES, DDS, INC.
Entity Type:Organization
Organization Name:EMELITO R. REYES, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EMELITO
Authorized Official - Middle Name:R
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-340-2782
Mailing Address - Street 1:6911 TOPANGA CANYON BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-2316
Mailing Address - Country:US
Mailing Address - Phone:818-340-2782
Mailing Address - Fax:
Practice Address - Street 1:6911 TOPANGA CANYON BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-2316
Practice Address - Country:US
Practice Address - Phone:818-340-2782
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-04
Last Update Date:2014-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA424041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty