MEDICARE: DR. RYAN PATRICK RILEY 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	122300000X	Dentist	DGD.10758	SC
2	122300000X	Dentist	7213	LA
3	1223E0200X	Endodontics	11236	SC

General Provider Information

NPI Number	:	1235703018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN PATRICK RILEY DDS

Provider Business Mailing Address
First Line	:	510 JOSEPH ST APT B
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29412-3256
Country	:	US
Telephone Number	:	601-955-2732
Fax Number	:

Provider Business Practice Location Address
First Line	:	2080 ROYLE RD UNIT D
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29486-1301
Country	:	US
Telephone Number	:	843-970-1948
Fax Number	:

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

Provider Enumeration Date	:	05/17/2021
Last Update Date	:	10/18/2025

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