Individual
ELIO REYES ROSALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.S.D.
Contact information
Practice address
11 PARK PL, SUITE A, SWANSEA, IL 62226-2925
(618) 233-7300
Mailing address
933 ESIC DR, EDWARDSVILLE, IL 62025-3813
(314) 724-4852
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
019027808
IL
1223P0300X
Periodontics
Primary
021002297
IL
Other
Enumeration date
04/19/2012
Last updated
04/19/2012
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