Provider Demographics
NPI:1538438304
Name:REILY, DONALD JAMES (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:JAMES
Last Name:REILY
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:30 NORTH SLUSSER STREET
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030
Mailing Address - Country:US
Mailing Address - Phone:847-223-2876
Mailing Address - Fax:847-223-2807
Practice Address - Street 1:30 NORTH SLUSSER STREET
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030
Practice Address - Country:US
Practice Address - Phone:847-223-2876
Practice Address - Fax:847-223-2807
Is Sole Proprietor?:No
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL021.0011251223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics