Provider Demographics
NPI:1447786462
Name:TEJEDA GONZALEZ, REINIER (DDS)
Entity Type:Individual
Prefix:DR
First Name:REINIER
Middle Name:
Last Name:TEJEDA GONZALEZ
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 1:541 PORT MALABAR BLVD NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-4406
Mailing Address - Country:US
Mailing Address - Phone:321-557-4573
Mailing Address - Fax:
Practice Address - Street 1:249 PALM BAY RD NE
Practice Address - Street 2:
Practice Address - City:WEST MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-8602
Practice Address - Country:US
Practice Address - Phone:321-482-5220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN243241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice