Provider Demographics
NPI:1063615342
Name:REILLY FAMILY DENTAL LLC
Entity type:Organization
Organization Name:REILLY FAMILY DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEWEY
Authorized Official - Middle Name:IRVING
Authorized Official - Last Name:REILLY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:715-453-7071
Mailing Address - Street 1:PO BOX 287
Mailing Address - Street 2:
Mailing Address - City:TOMAHAWK
Mailing Address - State:WI
Mailing Address - Zip Code:54487
Mailing Address - Country:US
Mailing Address - Phone:715-453-7071
Mailing Address - Fax:715-453-9461
Practice Address - Street 1:1018 KING RD
Practice Address - Street 2:
Practice Address - City:TOMAHAWK
Practice Address - State:WI
Practice Address - Zip Code:54487
Practice Address - Country:US
Practice Address - Phone:715-453-7071
Practice Address - Fax:715-453-9461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5001190015122300000X
WI6009015122300000X
WI5005793122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty