Provider Demographics
NPI:1760830228
Name:GARCIA, REYNA GUADALUPE (DDS)
Entity Type:Individual
Prefix:
First Name:REYNA
Middle Name:GUADALUPE
Last Name:GARCIA
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:PO BOX 80257
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208-8004
Mailing Address - Country:US
Mailing Address - Phone:414-935-8000
Mailing Address - Fax:414-344-3396
Practice Address - Street 1:3522 W LISBON AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208
Practice Address - Country:US
Practice Address - Phone:414-935-8000
Practice Address - Fax:414-935-8011
Is Sole Proprietor?:No
Enumeration Date:2016-05-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001340122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
13836184OtherCAQH
1760830228OtherNPI
1760830228OtherNPI