Provider Demographics
NPI:1699058750
Name:REILLY, CHERYLE (DMD)
Entity type:Individual
Prefix:
First Name:CHERYLE
Middle Name:
Last Name:REILLY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:CHERYLE
Other - Middle Name:
Other - Last Name:REILLY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:206-1445 MARPOLE AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:BC
Mailing Address - Zip Code:V6H1S5
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3227 W BLUE RIDGE DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29611-3905
Practice Address - Country:US
Practice Address - Phone:313-848-0679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2017-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC88851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice