MEDICARE: DR. REA GHODASRA DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	LL-605-24	NV

General Provider Information

NPI Number	:	1316882640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REA GHODASRA DMD

Provider Business Mailing Address
First Line	:	32201 TRIBECA AVE
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33543-7568
Country	:	US
Telephone Number	:	609-317-0015
Fax Number	:

Provider Business Practice Location Address
First Line	:	4 SUNSET WAY
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89014-2015
Country	:	US
Telephone Number	:	609-317-0015
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2026
Last Update Date	:	04/22/2026

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