Provider Demographics
NPI:1043669815
Name:REYES GARCIA, EDGAR (DDS)
Entity type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:
Last Name:REYES GARCIA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 S MELROSE DR, SUITE A
Mailing Address - Street 2:#257
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-5407
Mailing Address - Country:US
Mailing Address - Phone:209-568-5782
Mailing Address - Fax:760-598-6034
Practice Address - Street 1:1631 S MELROSE DR STE I
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-2405
Practice Address - Country:US
Practice Address - Phone:760-598-7565
Practice Address - Fax:760-598-6034
Is Sole Proprietor?:No
Enumeration Date:2016-06-12
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100278122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist