Provider Demographics
NPI:1063375517
Name:REYES CORDERO, OMAR NOE
Entity type:Individual
Prefix:
First Name:OMAR
Middle Name:NOE
Last Name:REYES CORDERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11964 MEDALLA ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79927
Mailing Address - Country:US
Mailing Address - Phone:915-215-9491
Mailing Address - Fax:
Practice Address - Street 1:CALLE MELQUIADES ALANIS #6211
Practice Address - Street 2:
Practice Address - City:CD. JUAREZ
Practice Address - State:CHUHUAHUA
Practice Address - Zip Code:32320
Practice Address - Country:MX
Practice Address - Phone:
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-12-03
Last Update Date:2025-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty