MEDICARE: JUAQUIN REYES DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	122300000X	Dentist	39559	TX

General Provider Information

NPI Number	:	1396436663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUAQUIN REYES DDS

Provider Business Mailing Address
First Line	:	12339 VILLAGER CT
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33625-6547
Country	:	US
Telephone Number	:	813-753-3756
Fax Number	:

Provider Business Practice Location Address
First Line	:	10936 NORTH FWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77037-1108
Country	:	US
Telephone Number	:	936-236-9566
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2023
Last Update Date	:	06/19/2023

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