Centro Dental Dra. Reyes PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

048089 Issued in NY

Legal business name

CENTRO DENTAL DRA. REYES PLLC

Practice address

1569 Saint Nicholas Ave
New York, NY 10040-4261

Phone

(212) 740-2800

Fax

(212) 740-1900

NPI assigned

Mar 28, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Fabiola Antillana Reyes, D.D.SNPI 1396934915

Title

General Dentist

Phone

(212) 740-2800

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Fabiola A Reyes, DDS

  • Dentist
  • New York, NY
  • NPI 1396934915
  NPD (past) Authorized official

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

{
    "created_epoch": "1206662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1206662400000",
    "number": "1346412459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1569 SAINT NICHOLAS AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100404261",
            "telephone_number": "212-740-2800",
            "fax_number": "212-740-1900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1569 SAINT NICHOLAS AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100404261",
            "telephone_number": "212-740-2800",
            "fax_number": "212-740-1900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRO DENTAL DRA. REYES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-28",
        "last_updated": "2008-03-28",
        "status": "A",
        "authorized_official_last_name": "REYES",
        "authorized_official_first_name": "FABIOLA",
        "authorized_official_middle_name": "ANTILLANA",
        "authorized_official_title_or_position": "GENERAL DENTIST",
        "authorized_official_telephone_number": "212-740-2800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NY",
            "license": "048089",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01926416",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dental Clinic/Center in New York, NY
• Providers in New York, NY by specialty
• Dental Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.