Provider Demographics
NPI:1245877992
Name:REYES GARCIA & O'CONNOR DENTAL, INC.
Entity type:Organization
Organization Name:REYES GARCIA & O'CONNOR DENTAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:O'CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-598-7565
Mailing Address - Street 1:1611 S. MELROSE DR.
Mailing Address - Street 2:STE. A #257
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081
Mailing Address - Country:US
Mailing Address - Phone:760-598-7565
Mailing Address - Fax:
Practice Address - Street 1:1631 S MELROSE DR STE I
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-2405
Practice Address - Country:US
Practice Address - Phone:760-598-7565
Practice Address - Fax:760-598-7565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-02
Last Update Date:2020-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty