Provider Demographics
NPI:1619448677
Name:DUARTE REIS, POLIANA MENDES (DDS, MS, PHD)
Entity Type:Individual
Prefix:DR
First Name:POLIANA
Middle Name:MENDES
Last Name:DUARTE REIS
Suffix:
Gender:F
Credentials:DDS, MS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3321 SW 118TH TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-1196
Mailing Address - Country:US
Mailing Address - Phone:352-281-4179
Mailing Address - Fax:
Practice Address - Street 1:1395 CENTER DRIVE D1-11 - FACULTY PRACTICE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-0001
Practice Address - Country:US
Practice Address - Phone:352-273-7954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6871223P0300X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0300XDental ProvidersDentistPeriodontics