Provider Demographics
NPI:1548232291
Name:REYES DE LOBOS, MARIBEL (DDS)
Entity Type:Individual
Prefix:
First Name:MARIBEL
Middle Name:
Last Name:REYES DE LOBOS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 S PAULINA ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-7210
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF ILLINOIS AT CHICAGO COLLEGE OF DENTISTRY
Practice Address - Street 2:801 S PAULINA MC 850
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-996-7531
Practice Address - Fax:970-867-7607
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0258991223P0221X
IL0210024961223P0221X
CO87421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO64178242Medicaid