Provider Demographics
NPI:1447084439
Name:POIRIER, REILLY LYNNE (RDH, OMT)
Entity type:Individual
Prefix:
First Name:REILLY
Middle Name:LYNNE
Last Name:POIRIER
Suffix:
Gender:F
Credentials:RDH, OMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6035 SANDSTONE CIR
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:CO
Mailing Address - Zip Code:80516-9731
Mailing Address - Country:US
Mailing Address - Phone:774-212-0761
Mailing Address - Fax:
Practice Address - Street 1:767 PEARL ST STE 230
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5061
Practice Address - Country:US
Practice Address - Phone:303-449-8875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO002024573124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist