Provider Demographics
NPI:1407801830
Name:MARIANO, ARNEL REYES (DDS)
Entity Type:Individual
Prefix:DR
First Name:ARNEL
Middle Name:REYES
Last Name:MARIANO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743 EMORY ST
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:91932-2231
Mailing Address - Country:US
Mailing Address - Phone:619-424-8707
Mailing Address - Fax:619-424-8712
Practice Address - Street 1:743 EMORY ST
Practice Address - Street 2:SUITE A
Practice Address - City:IMPERIAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:91932-2231
Practice Address - Country:US
Practice Address - Phone:619-424-8707
Practice Address - Fax:619-424-8712
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA407751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice