Individual
ANDREA E REALE REYES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
801 S PAULINA ST, CHICAGO, IL 60612-7210
(312) 996-9158
Mailing address
801 S PAULINA ST OFC 204A, CHICAGO, IL 60612-7210
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
136.000223
IL
1223G0001X
General Practice Dentistry
Primary
019.033459
IL
Other
Enumeration date
10/26/2018
Last updated
04/07/2022
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