MEDICARE: DR. ROBERTO ODRACIR REYES 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	DN24858	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386268894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERTO ODRACIR REYES DMD

Provider Business Mailing Address
First Line	:	1470 LUCERNE LOOP RD NE
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33881-9329
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3501 CYPRESS GARDENS RD
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33884-2459
Country	:	US
Telephone Number	:	863-268-2300
Fax Number	:

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

Provider Enumeration Date	:	05/31/2020
Last Update Date	:	06/06/2026

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