Provider Demographics
NPI:1821648031
Name:O'REILLY FAMILY DENTAL
Entity Type:Organization
Organization Name:O'REILLY FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:O'REILLY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:847-683-3464
Mailing Address - Street 1:179 E OAK KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:HAMPSHIRE
Mailing Address - State:IL
Mailing Address - Zip Code:60140-9095
Mailing Address - Country:US
Mailing Address - Phone:847-494-2507
Mailing Address - Fax:
Practice Address - Street 1:179 E OAK KNOLL DR
Practice Address - Street 2:
Practice Address - City:HAMPSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60140-9095
Practice Address - Country:US
Practice Address - Phone:847-494-2507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty