Basic Information
| Provider Information | |||||||||
| NPI: | 1659677227 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REYES | ||||||||
| FirstName: | MILAGROS | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | |||||||||
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| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 314 MANNING AVE | ||||||||
| Address2: | |||||||||
| City: | LEOMINSTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9788470110 | ||||||||
| FaxNumber: | 9788788152 | ||||||||
| Practice Location | |||||||||
| Address1: | 14 MANNING AVE | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | LEOMINSTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 014535768 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9788470110 | ||||||||
| FaxNumber: | 9788470112 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2011 | ||||||||
| LastUpdateDate: | 12/11/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | DL10983 | MA | Y | Dental Providers | Dentist |
No ID Information.