Active NPI
Nikolaas Enrique Reyna, DDS
- General Practice Dentistry
- Puyallup, WA
National Provider Identifier
1083178560
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 60889505
- Practice address
- 8012 112TH Street CT E Ste 320
Puyallup, WA 98373-7856 - Phone
- (253) 848-2331
- NPI assigned
- Jan 29, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 60889505 | WA | Primary |
Addresses
Primary practice location
8012 112TH Street CT E Ste 320
Puyallup, WA 98373-7856
Mailing address
8012 112TH Street CT E Ste 20
Puyallup, WA 98373-7856
Phone (253) 848-2331
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 60889505 | WA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1548720000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1548720000000",
"number": "1083178560",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8012 112TH STREET CT E STE 20",
"city": "PUYALLUP",
"state": "WA",
"postal_code": "983737856",
"telephone_number": "253-848-2331"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8012 112TH STREET CT E STE 320",
"city": "PUYALLUP",
"state": "WA",
"postal_code": "983737856",
"telephone_number": "253-848-2331"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REYNA",
"first_name": "NIKOLAAS",
"middle_name": "ENRIQUE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-01-29",
"last_updated": "2019-01-29",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "WA",
"license": "60889505",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Puyallup, WA
- Ret Sunrise Physical Therapy, PLLC
- Lise S. Retailliau, D.O.
- Reilly Elizabeth Retz, DPT
- Revera (Delaware) LLC (Linden Grove Health Care Center)
- Revitalize and Restore Therapy (Rachael Jordan)
- Levi Reynolds, DDS
- Nancy Reynolds, RN
- Rhonda Rayleen Rhoades, MA, LMHC, CTMH
- Kelcey P Rhodes, DDS
- Thomas Charles Rhodes, DDS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.