MEDICARE: DR. DELIA T. REYES D.M.D

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	122300000X	Dentist	20284	FL

General Provider Information

NPI Number	:	1871935379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DELIA T. REYES D.M.D

Provider Business Mailing Address
First Line	:	80 WILSON BLVD S
Second Line	:	SUITE 12
City	:	NAPLES
State	:	FL
Zip	:	34117-9386
Country	:	US
Telephone Number	:	239-431-8353
Fax Number	:	239-431-8378

Provider Business Practice Location Address
First Line	:	80 WILSON BLVD S
Second Line	:	SUITE 12
City	:	NAPLES
State	:	FL
Zip	:	34117-9386
Country	:	US
Telephone Number	:	239-431-8353
Fax Number	:	239-431-8378

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

Provider Enumeration Date	:	07/24/2013
Last Update Date	:	12/19/2015

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