Provider Demographics
NPI:1487720603
Name:REYES, JEFFREY MARIN (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MARIN
Last Name:REYES
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 1:25846 MCBEAN PKWY
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-2004
Mailing Address - Country:US
Mailing Address - Phone:661-259-0600
Mailing Address - Fax:661-259-0633
Practice Address - Street 1:25846 MCBEAN PKWY
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-2004
Practice Address - Country:US
Practice Address - Phone:661-259-0600
Practice Address - Fax:661-259-0633
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA532681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice