=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457215832
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHANTAL C REYES LIRA RDH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/10/2025
-----------------------------------------------------
Last Update Date | 12/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5800 OVERSEAS HWY STE 38
-----------------------------------------------------
City | MARATHON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33050-2744
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-743-7111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5800 OVERSEAS HWY STE 38
-----------------------------------------------------
City | MARATHON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33050-2744
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-743-7111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 124Q00000X
-----------------------------------------------------
Taxonomy Name | Dental Hygienist
-----------------------------------------------------
License Number | DH34093
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------