Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 2703 | PR |
NPI | 1265533178 |
---|---|
Provider Name | Dr. Roberto Reyes |
First Address | Pawnee, OK 74058-3744 |
Second Address | Pawnee, OK 74058-3744 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 08/07/2007 |