Provider Demographics
NPI:1447826938
Name:JORGE REYES DENTAL CORP
Entity type:Organization
Organization Name:JORGE REYES DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-220-5995
Mailing Address - Street 1:950 E PENNSYLVANIA AVE STE B
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3436
Mailing Address - Country:US
Mailing Address - Phone:760-220-5995
Mailing Address - Fax:760-741-5775
Practice Address - Street 1:950 E PENNSYLVANIA AVE STE B
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3436
Practice Address - Country:US
Practice Address - Phone:760-220-5995
Practice Address - Fax:760-741-5775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty