Healthcare Provider Details

I. General information

NPI: 1245022128
Provider Name (Legal Business Name): THERESE COLLEEN REARDON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8915 W CONNELL AVE
MILWAUKEE WI
53226-3067
US

IV. Provider business mailing address

177 E ORCHARD ST
ELMHURST IL
60126-4063
US

V. Phone/Fax

Practice location:
  • Phone: 414-266-1788
  • Fax:
Mailing address:
  • Phone: 630-877-6750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: