MEDICARE: OLIVIA REYES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	019.036517	IL

General Provider Information

NPI Number	:	1396359980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA REYES

Provider Business Mailing Address
First Line	:	445 E ILLINOIS ST UNIT 4603
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-5370
Country	:	US
Telephone Number	:	707-330-5651
Fax Number	:

Provider Business Practice Location Address
First Line	:	355 GREENLEAF ST STE E
Second Line	:
City	:	PARK CITY
State	:	IL
Zip	:	60085-5708
Country	:	US
Telephone Number	:	847-249-5700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2020
Last Update Date	:	12/09/2025

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Directions to “ OLIVIA REYES ” Practice Location

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