Provider Demographics
NPI:1871705525
Name:LAESCH-REYES, DIANE MARY (RDH)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:MARY
Last Name:LAESCH-REYES
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4025 STATE ST
Mailing Address - Street 2:#44
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93110-1820
Mailing Address - Country:US
Mailing Address - Phone:805-696-6219
Mailing Address - Fax:
Practice Address - Street 1:STUDENT HEALTH
Practice Address - Street 2:UNIVERSITY OF CALIFORNIA
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93106-7002
Practice Address - Country:US
Practice Address - Phone:805-893-2891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18571124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist