Provider Demographics
NPI:1710416318
Name:REILLY, PATRICK ANDREW (DMD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:ANDREW
Last Name: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 1:75 CONANT RD
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-1805
Mailing Address - Country:US
Mailing Address - Phone:781-351-1355
Mailing Address - Fax:
Practice Address - Street 1:635 TREMONT ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-1346
Practice Address - Country:US
Practice Address - Phone:617-424-0606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18593211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice