Healthcare Provider Details

I. General information

NPI: 1013964147
Provider Name (Legal Business Name): D. CALVIN RILEY JR. DMD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 08/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 17TH AVE SO
NORTH MYRTLE BEACH SC
29582
US

IV. Provider business mailing address

602 17TH AVE SO
NORTH MYRTLE BEACH SC
29582
US

V. Phone/Fax

Practice location:
  • Phone: 843-272-1121
  • Fax: 843-272-9976
Mailing address:
  • Phone: 843-272-1121
  • Fax: 843-272-9976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2681
License Number StateSC

VIII. Authorized Official

Name: DON CALVIN RILEY JR.
Title or Position: DENTIST OWNER
Credential:
Phone: 843-272-1121