MEDICARE: CHERYLE REILLY DMD

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	1223G0001X	General Practice Dentistry	8885	SC

General Provider Information

NPI Number	:	1699058750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYLE REILLY DMD

Provider Business Mailing Address
First Line	:	206-1445 MARPOLE AVE
Second Line	:
City	:	VANCOUVER
State	:	BC
Zip	:	V6H1S5
Country	:	CA
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3227 W BLUE RIDGE DR
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29611-3905
Country	:	US
Telephone Number	:	313-848-0679
Fax Number	:

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

Provider Enumeration Date	:	09/26/2011
Last Update Date	:	06/05/2017

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