Provider Demographics
NPI:1467923995
Name:REYES, VERONICA (RDH)
Entity Type:Individual
Prefix:MS
First Name:VERONICA
Middle Name:
Last Name:REYES
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 E 16TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68801-2523
Mailing Address - Country:US
Mailing Address - Phone:402-519-8455
Mailing Address - Fax:
Practice Address - Street 1:638 N WEBB RD STE 1
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4057
Practice Address - Country:US
Practice Address - Phone:308-381-0167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2594124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist