Healthcare Provider Details

I. General information

NPI: 1710087911
Provider Name (Legal Business Name): WILLIAM LOUIS RIES D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 ASHLEY AVE ROOM 346 BSB
CHARLESTON SC
29425-0001
US

IV. Provider business mailing address

405 ROYAL PALM BLVD APT. 202
CHARLESTON SC
29407-3205
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-3444
  • Fax: 843-792-0348
Mailing address:
  • Phone: 843-402-6986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number3185 0439
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: