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Organization
MG REYES DENTAL CORPORATION
Active
Organization
MG REYES DENTAL CORPORATION
Active
Parent organization
SAN GABRIEL DENTAL PRACTICE
Other names
MG Reyes Dental Corporation
Organization subpart
Yes
Provider details
NPI number
Legal business name
SAN GABRIEL DENTAL PRACTICE
Authorized official
DR. MARTIN G REYES (OWNER)
(626) 962-8160
Entity
Organization
Contact information
Practice address
14323 RAMONA BLVD, BALDWIN PARK, CA 91706-3242
(626) 962-8160
Mailing address
14323 RAMONA BLVD, BALDWIN PARK, CA 91706-3242
(626) 962-8160
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1619184223
DENTI-CAL
CA
05
—
1619184223
—
CA
Enumeration date
07/31/2019
Last updated
12/09/2019
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