Provider Demographics
NPI:1902212616
Name:REYES, SHARIE TAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHARIE
Middle Name:TAN
Last Name:REYES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SHARIE
Other - Middle Name:LIAO
Other - Last Name:TAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:90 ZITA MNR
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2049
Mailing Address - Country:US
Mailing Address - Phone:650-534-5291
Mailing Address - Fax:650-757-6556
Practice Address - Street 1:455 HICKEY BLVD
Practice Address - Street 2:SUITE 410
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2629
Practice Address - Country:US
Practice Address - Phone:650-757-6688
Practice Address - Fax:650-757-6556
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA617231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice