Provider Demographics
NPI:1952519241
Name:DELOS REYES, IRMA R (DMD)
Entity type:Individual
Prefix:
First Name:IRMA
Middle Name:R
Last Name:DELOS 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 1:12800 HOLLAND PARK ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-5754
Mailing Address - Country:US
Mailing Address - Phone:661-589-4104
Mailing Address - Fax:
Practice Address - Street 1:2236 GIRARD ST
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215-3808
Practice Address - Country:US
Practice Address - Phone:661-721-3656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA422991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice