Provider Demographics
NPI:1528052651
Name:REES, ILENE L (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:ILENE
Middle Name:L
Last Name:REES
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 61970
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76906
Mailing Address - Country:US
Mailing Address - Phone:325-949-4100
Mailing Address - Fax:
Practice Address - Street 1:3123 GREEN MEADOW DR
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904
Practice Address - Country:US
Practice Address - Phone:325-949-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-05
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX188081223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics