Provider Demographics
NPI:1295775575
Name:REILLY, THOMAS VINCENT (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:VINCENT
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 1:135 E MARKET ST
Mailing Address - Street 2:SUITE 116
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15717-1369
Mailing Address - Country:US
Mailing Address - Phone:724-459-5310
Mailing Address - Fax:742-459-3635
Practice Address - Street 1:135 E MARKET ST
Practice Address - Street 2:SUITE 116
Practice Address - City:BLAIRSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15717-1369
Practice Address - Country:US
Practice Address - Phone:724-459-5310
Practice Address - Fax:742-459-3635
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS018630L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice