Provider Demographics
NPI:1437281250
Name:RILEY, DON CALVIN JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:DON
Middle Name:CALVIN
Last Name:RILEY
Suffix:JR
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 1:602 17TH AVE SO
Mailing Address - Street 2:
Mailing Address - City:NO MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582
Mailing Address - Country:US
Mailing Address - Phone:843-272-1121
Mailing Address - Fax:843-272-9976
Practice Address - Street 1:602 17TH AVE SO
Practice Address - Street 2:
Practice Address - City:NO MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582
Practice Address - Country:US
Practice Address - Phone:843-272-1121
Practice Address - Fax:843-272-9976
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZZ2681Medicaid