MEDICARE: DR. GREGORY DEEMS PRIESTON DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	9348	SC

General Provider Information

NPI Number	:	1215931688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY DEEMS PRIESTON DDS

Provider Business Mailing Address
First Line	:	P.O BOX 1570
Second Line	:
City	:	LITTLE RIVER
State	:	SC
Zip	:	29566
Country	:	US
Telephone Number	:	203-504-2067
Fax Number	:	203-853-7073

Provider Business Practice Location Address
First Line	:	4032-2 RIVER OAKS DR.
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579
Country	:	US
Telephone Number	:	843-903-8800
Fax Number	:	203-853-7073

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	07/29/2019

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