Healthcare Provider Details

I. General information

NPI: 1457215832
Provider Name (Legal Business Name): CHANTAL C REYES LIRA RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHANTAL CRISTINA GONCALVES RDH

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 OVERSEAS HWY STE 38
MARATHON FL
33050-2744
US

IV. Provider business mailing address

5800 OVERSEAS HWY STE 38
MARATHON FL
33050-2744
US

V. Phone/Fax

Practice location:
  • Phone: 305-743-7111
  • Fax:
Mailing address:
  • Phone: 305-743-7111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH34093
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: