Provider Demographics
NPI:1013063882
Name:REYES, BENJAMIN GONZALEZ (DMD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:GONZALEZ
Last Name:REYES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PMB 320 1575 AVE MUNOZ RIVERA
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-0211
Mailing Address - Country:US
Mailing Address - Phone:787-259-5151
Mailing Address - Fax:787-290-4472
Practice Address - Street 1:PLAZOLETA LAS AMERICAS 2015
Practice Address - Street 2:AVE. LAS AMERICAS SUITE 101
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717
Practice Address - Country:US
Practice Address - Phone:787-259-5151
Practice Address - Fax:787-290-4472
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1142OtherLICENSE