MEDICARE: MICHAEL D. RIORDAN, D.M.D., P.C.

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	261QD0000X	Dental Clinic/Center	25540552	SC

General Provider Information

NPI Number	:	1821255191
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL D. RIORDAN, D.M.D., P.C.

Provider Business Mailing Address
First Line	:	1741 GOLD HILL RD
Second Line	:	SUITE 200
City	:	FORT MILL
State	:	SC
Zip	:	29708-8202
Country	:	US
Telephone Number	:	803-802-2580
Fax Number	:	803-802-3075

Provider Business Practice Location Address
First Line	:	1741 GOLD HILL RD
Second Line	:	SUITE 200
City	:	FORT MILL
State	:	SC
Zip	:	29708-8202
Country	:	US
Telephone Number	:	803-802-2580
Fax Number	:	803-802-3075

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL DAVID RIORDAN
Credential	:	DMD
Telephone Number	:	803-802-2580

Provider Enumeration Date	:	05/22/2008
Last Update Date	:	05/22/2008

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