Individual provider Active NPI

Edgar Reyes Garcia, DDS

  • Dentist
  • Vista, CA
National Provider Identifier
1043669815
Registry record updated Feb 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
100278 Issued in CA
Practice address
1631 S Melrose Dr Ste I
Vista, CA 92081-2405
Phone
(760) 598-7565
Fax
(760) 598-6034
NPI assigned
Jun 12, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 100278 CA Primary

Addresses

Primary practice location

1631 S Melrose Dr Ste I
Vista, CA 92081-2405

Mailing address

1611 S Melrose Dr, Suite a
#257
Vista, CA 92081-5407
Phone (209) 568-5782

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160720001109 CA Order and Referring Only - DentistPractitioner - Dentist 3971896515

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
100278CAMDSports Medicine (Family Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Reyes Garcia & O'Connor Dental, Inc. CurrentSince Feb 9, 2020 Accepting new patients

Locations

1611 S Melrose Dr
Ste A
Vista, CA 92081
Phone (760) 230-3451

1631 S Melrose Dr
Ste I
Vista, CA 92081
Phone (760) 598-7565

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1465689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581033600000",
    "number": "1043669815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1611 S MELROSE DR, SUITE A",
            "address_2": "#257",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920815407",
            "telephone_number": "209-568-5782",
            "fax_number": "760-598-6034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1631 S MELROSE DR STE I",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920812405",
            "telephone_number": "760-598-7565",
            "fax_number": "760-598-6034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYES GARCIA",
        "first_name": "EDGAR",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-12",
        "last_updated": "2020-02-07",
        "certification_date": "2020-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "100278",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vista, CA

Sources for this page

Verify at the official NPI Registry.