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General NPI Number Information
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NPI Number | 1376721985
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Entity Type | Individual
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Provider Name | JOSE B DE LOS REYES DMD
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Gender | Male
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Dates
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Enumeration Date | 02/06/2008
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Last Update Date | 02/06/2008
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Provider Practice Location Address
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Address Line | 300 NORTH MILWAUKEE AVENUE SUITE A
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City | LAKE VILLA
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State | IL
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Zip | 60046
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Country | US
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Telephone | 847-699-2358
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Fax | 847-265-0744
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Provider Business Mailing Address
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Address Line | PO BOX 188 300 NORTH MILWAUKEE AVENUE SUITE A
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City | LAKE VILLA
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State | IL
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Zip | 60046
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Country | US
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Telephone | 847-699-2358
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Fax | 847-265-0744
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State | IL
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