Individual
DR. ROBERT KEVIN REILLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
401 SECOND STREET, MANAWA, WI 54949
(920) 596-3133
(920) 596-3133
Mailing address
PO BOX 956, MANAWA, WI 54949
(920) 596-3133
(920) 596-3133
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2765
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33428100
—
WI
Enumeration date
08/24/2006
Last updated
07/08/2007
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