Provider Demographics
NPI:1750991857
Name:REYES, KELSEY MICHELLE (DDS)
Entity type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:MICHELLE
Last Name:REYES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 PROBANDT UNIT 411
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78204-1998
Mailing Address - Country:US
Mailing Address - Phone:830-556-4853
Mailing Address - Fax:
Practice Address - Street 1:1255 ASHBY ST
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-5118
Practice Address - Country:US
Practice Address - Phone:830-379-9757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice