MEDICARE: DANELYN ODETTE 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	1223G0001X	General Practice Dentistry	DN1858300	MA

General Provider Information

NPI Number	:	1609432723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANELYN ODETTE REYES

Provider Business Mailing Address
First Line	:	251 CORBETT ST
Second Line	:
City	:	FALL RIVER
State	:	MA
Zip	:	02720-6626
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1395 PLEASANT ST
Second Line	:
City	:	FALL RIVER
State	:	MA
Zip	:	02723-1718
Country	:	US
Telephone Number	:	508-672-8984
Fax Number	:

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

Provider Enumeration Date	:	05/14/2019
Last Update Date	:	06/03/2019

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