Provider Demographics
NPI:1578963815
Name:E.P. REYES DENTAL, INC
Entity Type:Organization
Organization Name:E.P. REYES DENTAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:PAA
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:510-487-6265
Mailing Address - Street 1:32138 ALVARADO BLVD
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-4000
Mailing Address - Country:US
Mailing Address - Phone:510-487-6265
Mailing Address - Fax:
Practice Address - Street 1:32138 ALVARADO BLVD
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-4000
Practice Address - Country:US
Practice Address - Phone:510-487-6265
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-22
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB359791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB3597901Medicaid