MEDICARE: DR. PATRICK JAMES REILLY D.M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	10314	CO

General Provider Information

NPI Number	:	1407156680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICK JAMES REILLY D.M.D

Provider Business Mailing Address
First Line	:	559 VINCENT ST SPC BASE
Second Line	:
City	:	PETERSON AFB
State	:	CO
Zip	:	80914-1541
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1189 S PERRY ST STE 200
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80104-1967
Country	:	US
Telephone Number	:	303-688-3008
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/22/2010
Last Update Date	:	01/31/2025

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