Healthcare Provider Details

I. General information

NPI: 1891278768
Provider Name (Legal Business Name): ANDRE F REIS DDS, MS, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2018
Last Update Date: 09/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 CENTER DRIVE D1-11 - FACULTY PRACTICE
GAINESVILLE FL
32610-0001
US

IV. Provider business mailing address

3321 SW 118TH TER
GAINESVILLE FL
32608-1196
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-7954
  • Fax:
Mailing address:
  • Phone: 352-614-8932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number683
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: