Provider Demographics
NPI:1750874004
Name:REYES, CHERITH ROSE (DMD)
Entity type:Individual
Prefix:DR
First Name:CHERITH
Middle Name:ROSE
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 1:110 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7710
Mailing Address - Country:US
Mailing Address - Phone:207-784-2211
Mailing Address - Fax:207-784-2040
Practice Address - Street 1:110 CANAL ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7710
Practice Address - Country:US
Practice Address - Phone:207-784-2211
Practice Address - Fax:207-784-2040
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN46411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice