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NPI Code Detail

MEDICARE: DR. LARRY JOSEPH GOZUM REYES DDS

MEDICARE: DR. LARRY JOSEPH GOZUM REYES DDS
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
11223G0001XGeneral Practice Dentistry0401413250VA

General Provider Information

NPI Number : 1568743060
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LARRY JOSEPH GOZUM REYES DDS
Provider Business Mailing Address
First Line : 13568 DAVINCI LN
Second Line :
City : OAK HILL
State : VA
Zip : 20171-6107
Country : US
Telephone Number : 240-383-0399
Fax Number :
Provider Business Practice Location Address
First Line : 915 N QUINCY ST
Second Line :
City : ARLINGTON
State : VA
Zip : 22203-1907
Country : US
Telephone Number : 703-276-1010
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2011
Last Update Date : 08/30/2011

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