Provider Demographics
NPI:1447236963
Name:REILLY, MICHAEL S (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:REILLY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 ROLFE SQ
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-2809
Mailing Address - Country:US
Mailing Address - Phone:401-781-7349
Mailing Address - Fax:401-467-4996
Practice Address - Street 1:21 ROLFE SQ
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-2809
Practice Address - Country:US
Practice Address - Phone:401-781-7349
Practice Address - Fax:401-467-4996
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI21821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice