Provider Demographics
NPI:1265533178
Name:REYES, ROBERTO (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:
Last Name:REYES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:ROBERTO
Other - Middle Name:
Other - Last Name:REYES-RAMOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:22103 E 101ST PL S
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-4332
Mailing Address - Country:US
Mailing Address - Phone:787-402-1536
Mailing Address - Fax:
Practice Address - Street 1:10321 N 2274 RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-7521
Practice Address - Country:US
Practice Address - Phone:158-032-3288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK59961223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health