Healthcare Provider Details

I. General information

NPI: 1265533178
Provider Name (Legal Business Name): ROBERTO REYES DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ROBERTO REYES-RAMOS DMD

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10321 N 2274 RD
CLINTON OK
73601-7521
US

IV. Provider business mailing address

22103 E 101ST PL S
BROKEN ARROW OK
74014-4332
US

V. Phone/Fax

Practice location:
  • Phone: 158-032-3288
  • Fax:
Mailing address:
  • Phone: 787-402-1536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number5996
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: