Provider Demographics
NPI:1285246694
Name:REILLY, MEGHAN E (DMD)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:E
Last Name:REILLY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4494 ROSEMARY WAY UNIT 1
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:MN
Mailing Address - Zip Code:55038-6011
Mailing Address - Country:US
Mailing Address - Phone:651-675-9037
Mailing Address - Fax:
Practice Address - Street 1:2701 S MINNESOTA AVE STE 3
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-4746
Practice Address - Country:US
Practice Address - Phone:605-250-4651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD1286122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist