Provider Demographics
NPI:1659677227
Name:REYES, MILAGROS ELIZABETH (DMD)
Entity type:Individual
Prefix:
First Name:MILAGROS
Middle Name:ELIZABETH
Last Name:REYES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 MANNING AVE
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453
Mailing Address - Country:US
Mailing Address - Phone:978-847-0110
Mailing Address - Fax:978-878-8152
Practice Address - Street 1:14 MANNING AVE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-5768
Practice Address - Country:US
Practice Address - Phone:978-847-0110
Practice Address - Fax:978-847-0112
Is Sole Proprietor?:No
Enumeration Date:2011-01-31
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL10983122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist