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General NPI Number Information
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NPI Number | 1265533178
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Entity Type | Individual
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Provider Name | ROBERTO REYES DMD
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Gender | Male
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 10321 N 2274 RD
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City | CLINTON
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State | OK
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Zip | 73601-7521
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Country | US
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Telephone | 158-032-3288
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Fax |
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Provider Business Mailing Address
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Address Line | 22103 E 101ST PL S
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City | BROKEN ARROW
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State | OK
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Zip | 74014-4332
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Country | US
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Telephone | 787-402-1536
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | 5996
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License Number State | OK
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