Provider Demographics
NPI:1043693138
Name:O'REILLY, BRADLEY (DMD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:O'REILLY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 E WOODFIELD RD
Mailing Address - Street 2:STE 150
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-5905
Mailing Address - Country:US
Mailing Address - Phone:847-619-0330
Mailing Address - Fax:847-517-8124
Practice Address - Street 1:1701 E WOODFIELD RD
Practice Address - Street 2:STE 150
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-5905
Practice Address - Country:US
Practice Address - Phone:847-619-0330
Practice Address - Fax:847-517-8124
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0302241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice