Provider Demographics
NPI:1295116481
Name:DEVERS REYES, CAROLINA (DMD)
Entity type:Individual
Prefix:DR
First Name:CAROLINA
Middle Name:
Last Name:DEVERS REYES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-4004
Mailing Address - Country:US
Mailing Address - Phone:215-925-2400
Mailing Address - Fax:215-925-9462
Practice Address - Street 1:2520 SNYDER AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-3101
Practice Address - Country:US
Practice Address - Phone:215-755-6866
Practice Address - Fax:215-334-1381
Is Sole Proprietor?:No
Enumeration Date:2015-06-12
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS040456122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist