MEDICARE: E.P. REYES DENTAL, INC

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	1223G0001X	General Practice Dentistry	B35979	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578963815
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	E.P. REYES DENTAL, INC

Provider Business Mailing Address
First Line	:	32138 ALVARADO BLVD
Second Line	:
City	:	UNION CITY
State	:	CA
Zip	:	94587-4000
Country	:	US
Telephone Number	:	510-487-6265
Fax Number	:

Provider Business Practice Location Address
First Line	:	32138 ALVARADO BLVD
Second Line	:
City	:	UNION CITY
State	:	CA
Zip	:	94587-4000
Country	:	US
Telephone Number	:	510-487-6265
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/DENTIST
Name	:	DR. EDWIN PAA REYES
Credential	:	DMD
Telephone Number	:	510-487-6265

Provider Enumeration Date	:	08/22/2014
Last Update Date	:	08/22/2014

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