MEDICARE: LYSSA ARRAIS REED D.D.S.

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	28150	TX

General Provider Information

NPI Number	:	1699030338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYSSA ARRAIS REED D.D.S.

Provider Business Mailing Address
First Line	:	11010 W FM 471
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78253-4851
Country	:	US
Telephone Number	:	210-688-9386
Fax Number	:

Provider Business Practice Location Address
First Line	:	11010 W FM 471
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78253-4851
Country	:	US
Telephone Number	:	210-688-9386
Fax Number	:

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

Provider Enumeration Date	:	07/09/2012
Last Update Date	:	08/15/2012

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