Provider Demographics
NPI:1558968743
Name:DR. TIMOTHY REILLY DDS PC
Entity Type:Organization
Organization Name:DR. TIMOTHY REILLY DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:REILLY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-642-4484
Mailing Address - Street 1:6405 TELEGRAPH RD BLDG C
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48301-1716
Mailing Address - Country:US
Mailing Address - Phone:248-642-4484
Mailing Address - Fax:248-885-8704
Practice Address - Street 1:6405 TELEGRAPH RD BLDG C
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48301-1716
Practice Address - Country:US
Practice Address - Phone:248-642-4484
Practice Address - Fax:248-885-8704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental