Provider Demographics
NPI:1144735416
Name:CHARLES ANTHONY REYES, D.D.S., PC
Entity type:Organization
Organization Name:CHARLES ANTHONY REYES, D.D.S., PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:956-775-5151
Mailing Address - Street 1:7411 THOMAS HARRIS DR
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-2121
Mailing Address - Country:US
Mailing Address - Phone:956-775-5151
Mailing Address - Fax:
Practice Address - Street 1:2310 E SAUNDERS ST STE 3
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-5489
Practice Address - Country:US
Practice Address - Phone:956-775-5151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-08
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31968261QD0000X
1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX365040001Medicaid