Three Rivers Dental PLLC

Primary specialty

DentistTaxonomy code 122300000X

License

03795 Issued in NH

Legal business name

THREE RIVERS DENTAL PLLC

Practice address

655 Portsmouth Ave
Suite 9
Greenland, NH 03840-2246

Phone

(920) 284-8640

NPI assigned

Dec 13, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Logan Kevin Reilly, D.M.D.

Title

Sole Member

Phone

(920) 284-8640

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1355356800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355356800000",
    "number": "1881930105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "655 PORTSMOUTH AVE",
            "address_2": "SUITE 9",
            "city": "GREENLAND",
            "state": "NH",
            "postal_code": "038402246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 PORTSMOUTH AVE",
            "address_2": "SUITE 9",
            "city": "GREENLAND",
            "state": "NH",
            "postal_code": "038402246",
            "telephone_number": "920-284-8640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THREE RIVERS DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-13",
        "last_updated": "2012-12-13",
        "status": "A",
        "authorized_official_last_name": "REILLY",
        "authorized_official_first_name": "LOGAN",
        "authorized_official_middle_name": "KEVIN",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "920-284-8640",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "NH",
            "license": "03795",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shantel Surles, LMT
• Megan Dawn Swenson, LMT
• Vanessa Lee Sychak
• Jennifer Taylor, N.D.
• The Community Diversion Program
• Zoe Torres, LMT
• Town of Greenland, NH
• Ariel Elizabeth Wahl
• Marilyn Wanyo, LICSW
• Sarah Waterhouse, ND

• Dentist in Greenland, NH
• Providers in Greenland, NH by specialty
• Dentist in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.