Healthcare Provider Details

I. General information

NPI: 1679998165
Provider Name (Legal Business Name): JENNIFER REYES RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2014
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 NW BARSTOW ST SUITE 305
WAUKESHA WI
53188-3771
US

IV. Provider business mailing address

210 NW BARSTOW ST STE 305
WAUKESHA WI
53188-3771
US

V. Phone/Fax

Practice location:
  • Phone: 262-522-7645
  • Fax: 262-522-2828
Mailing address:
  • Phone: 262-522-7645
  • Fax: 262-522-2828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number11242-16
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: