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General NPI Number Information
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NPI Number | 1578963815
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Entity Type | Organization
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Legal Business Name | E.P. REYES DENTAL, INC
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Dates
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Enumeration Date | 08/22/2014
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Last Update Date | 08/22/2014
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Provider Practice Location Address
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Address Line | 32138 ALVARADO BLVD
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City | UNION CITY
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State | CA
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Zip | 94587-4000
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Country | US
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Telephone | 510-487-6265
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Fax |
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Provider Business Mailing Address
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Address Line | 32138 ALVARADO BLVD
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City | UNION CITY
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State | CA
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Zip | 94587-4000
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Country | US
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Telephone | 510-487-6265
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/DENTIST
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Name | DR. EDWIN PAA REYES
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Credential | DMD
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Telephone | 510-487-6265
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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 | B35979
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License Number State | CA
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