Healthcare Provider Details

I. General information

NPI: 1427780683
Provider Name (Legal Business Name): CRISNEL MORELIA REYES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9100 S DADELAND BLVD STE 502
MIAMI FL
33156-7815
US

IV. Provider business mailing address

10830 NW 52ND ST
DORAL FL
33178-3962
US

V. Phone/Fax

Practice location:
  • Phone: 786-890-7252
  • Fax:
Mailing address:
  • Phone: 786-285-8781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN29669
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: