Provider Demographics
NPI:1710370879
Name:REYES, JESSICA Y (BS AS)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:Y
Last Name:REYES
Suffix:
Gender:F
Credentials:BS AS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 JEWETT AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-2827
Mailing Address - Country:US
Mailing Address - Phone:917-544-1848
Mailing Address - Fax:
Practice Address - Street 1:63 BEAVER BROOK RD
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-6211
Practice Address - Country:US
Practice Address - Phone:203-797-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-13
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008197124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist