Healthcare Provider Details

I. General information

NPI: 1528991015
Provider Name (Legal Business Name): KATELYN RAE REILLY DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4727 E PECOS RD STE 101
GILBERT AZ
85295-0481
US

IV. Provider business mailing address

6233 W BEHREND DR APT 1072
GLENDALE AZ
85308-6924
US

V. Phone/Fax

Practice location:
  • Phone: 480-807-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD012828
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: