Provider Demographics
NPI:1164532628
Name:REILLY, CHRISTOPHER HAWLEY (DDS MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:HAWLEY
Last Name:REILLY
Suffix:
Gender:M
Credentials:DDS MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 AIRLINE DRIVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205
Mailing Address - Country:US
Mailing Address - Phone:518-456-6104
Mailing Address - Fax:518-456-5041
Practice Address - Street 1:10 AIRLINE DRIVE
Practice Address - Street 2:SUITE 204
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205
Practice Address - Country:US
Practice Address - Phone:518-456-6104
Practice Address - Fax:518-456-5041
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY430421122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U10394Medicare UPIN