Provider Demographics
NPI:1467757914
Name:REYES, ROLANDO GIOVANNI (DMD)
Entity type:Individual
Prefix:DR
First Name:ROLANDO
Middle Name:GIOVANNI
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 1:3450 WAYNE AVE
Mailing Address - Street 2:APT. 12E
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2510
Mailing Address - Country:US
Mailing Address - Phone:787-469-2394
Mailing Address - Fax:
Practice Address - Street 1:3450 WAYNE AVE
Practice Address - Street 2:APT. 12E
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2510
Practice Address - Country:US
Practice Address - Phone:787-469-2394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055366-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist