Provider Demographics
NPI:1891022372
Name:REYES-IBARRA, EUNICE (DDS)
Entity Type:Individual
Prefix:DR
First Name:EUNICE
Middle Name:
Last Name:REYES-IBARRA
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 1:788 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-8237
Mailing Address - Country:US
Mailing Address - Phone:413-445-6680
Mailing Address - Fax:413-443-3680
Practice Address - Street 1:788 SOUTH ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-8237
Practice Address - Country:US
Practice Address - Phone:413-445-6680
Practice Address - Fax:413-443-3680
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL10836122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist