Provider Demographics
NPI:1376530477
Name:REYES, EDGAR (DMD)
Entity Type:Individual
Prefix:MR
First Name:EDGAR
Middle Name:
Last Name:REYES
Suffix:
Gender:M
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:PMB 08 BOX 3001
Mailing Address - Street 2:
Mailing Address - City:BAJADERO
Mailing Address - State:PR
Mailing Address - Zip Code:00616-3001
Mailing Address - Country:US
Mailing Address - Phone:787-880-3943
Mailing Address - Fax:
Practice Address - Street 1:CARR. # 2 KM 70.2
Practice Address - Street 2:BO. SANTANA
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-880-0828
Practice Address - Fax:787-880-0828
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR26411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice