Provider Demographics
NPI:1477619682
Name:REYES, RALPH (DDS)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:
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 1:613 N AZUSA
Mailing Address - Street 2:STE B
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-5007
Mailing Address - Country:US
Mailing Address - Phone:626-334-2171
Mailing Address - Fax:626-334-0057
Practice Address - Street 1:613 N AZUSA
Practice Address - Street 2:STE B
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-5007
Practice Address - Country:US
Practice Address - Phone:626-334-2171
Practice Address - Fax:626-334-0057
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0345451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice