Healthcare Provider Details

I. General information

NPI: 1821648031
Provider Name (Legal Business Name): O'REILLY FAMILY DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2019
Last Update Date: 09/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179 E OAK KNOLL DR
HAMPSHIRE IL
60140-9095
US

IV. Provider business mailing address

179 E OAK KNOLL DR
HAMPSHIRE IL
60140-9095
US

V. Phone/Fax

Practice location:
  • Phone: 847-494-2507
  • Fax:
Mailing address:
  • Phone: 847-494-2507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. BRADLEY JOSEPH O'REILLY
Title or Position: DENTIST
Credential: DMD
Phone: 847-683-3464