Provider Demographics
NPI:1407948482
Name:REYES, MIGUEL A (DDS)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:A
Last Name:REYES
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 1:4410 W 16TH AVE
Mailing Address - Street 2:SUITE # 58
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7100
Mailing Address - Country:US
Mailing Address - Phone:305-826-5224
Mailing Address - Fax:305-826-0944
Practice Address - Street 1:4410 W 16TH AVE
Practice Address - Street 2:SUITE # 58
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7100
Practice Address - Country:US
Practice Address - Phone:305-826-5224
Practice Address - Fax:305-826-0944
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN111501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice