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General NPI Number Information
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NPI Number | 1952642571
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Entity Type | Individual
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Provider Name | KRYSTAL REYES VIRUET DMD
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Gender | Female
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Dates
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Enumeration Date | 03/06/2013
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Last Update Date | 08/28/2023
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Provider Practice Location Address
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Address Line | 34 BARKLEY CIR
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City | FORT MYERS
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State | FL
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Zip | 33907-7530
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Country | US
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Telephone | 239-275-6564
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Fax |
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Provider Business Mailing Address
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Address Line | 110 BERGEN ST D-881
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City | NEWARK
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State | NJ
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Zip | 07103-2495
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Country | US
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Telephone | 973-972-6613
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Fax |
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DN22982
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 3429
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License Number State | PR
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