Provider Demographics
NPI:1093880676
Name:RIORDAN, MICHAEL D (DMD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:RIORDAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1741 GOLD HILL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8202
Mailing Address - Country:US
Mailing Address - Phone:803-802-2580
Mailing Address - Fax:803-802-3075
Practice Address - Street 1:1741 GOLD HILL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-8202
Practice Address - Country:US
Practice Address - Phone:803-802-2580
Practice Address - Fax:803-802-3075
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC35541223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics