Provider Demographics
NPI:1841369691
Name:DILENA, REYNOLD J (MD)
Entity type:Individual
Prefix:
First Name:REYNOLD
Middle Name:J
Last Name:DILENA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2737 SHERMAN ST
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-1027
Mailing Address - Country:US
Mailing Address - Phone:972-647-1455
Mailing Address - Fax:972-606-9827
Practice Address - Street 1:2737 SHERMAN ST
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-1027
Practice Address - Country:US
Practice Address - Phone:972-647-1455
Practice Address - Fax:972-606-9827
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9449207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB22269Medicare ID - Type Unspecified
TXB22269Medicare UPIN