Provider Demographics
NPI:1558380972
Name:REYES, JOSE JUAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:JUAN
Last Name:REYES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:MRS
Other - First Name:DEENA
Other - Middle Name:A
Other - Last Name:OLIVARES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:9594 POTRANCO ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251
Mailing Address - Country:US
Mailing Address - Phone:210-523-2323
Mailing Address - Fax:210-314-1438
Practice Address - Street 1:9594 POTRANCO ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251
Practice Address - Country:US
Practice Address - Phone:210-523-2323
Practice Address - Fax:210-314-1438
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX217691223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist