Provider Demographics
NPI:1821394933
Name:O'RIELLY, CAREY ALEXANDER (DDS)
Entity Type:Individual
Prefix:
First Name:CAREY
Middle Name:ALEXANDER
Last Name:O'RIELLY
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 1:4403 MANCHESTER AVE
Mailing Address - Street 2:SUITE 206-B
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-4939
Mailing Address - Country:US
Mailing Address - Phone:760-632-1304
Mailing Address - Fax:760-632-1388
Practice Address - Street 1:4403 MANCHESTER AVE
Practice Address - Street 2:SUITE 206-B
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-4939
Practice Address - Country:US
Practice Address - Phone:760-632-1304
Practice Address - Fax:760-632-1388
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-07
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA323751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice