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602 17th Ave So North Myrtle Beach SC 29582 | |
| (843) 272-1121 | |
| (843) 272-9976 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 602 17th Ave So, North Myrtle Beach, South Carolina |
| Authorized Official Name and Position | Don Calvin Riley (DENTIST OWNER) |
| Authorized Official Contact | 8432721121 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
602 17th Ave So North Myrtle Beach SC 29582 Ph: (843) 272-1121 | 602 17th Ave So North Myrtle Beach SC 29582 Ph: (843) 272-1121 |
| NPI Number | 1013964147 |
|---|---|
| Provider Enumeration Date | 05/26/2006 |
| Last Update Date | 08/12/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013964147 | NPI | - | NPPES |
| ZZ2681 | Medicaid | SC | |
| ZA9478 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 2681 (South Carolina) | Primary |
Riesenberg Family Dental, Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 512 Highway 17 N, North Myrtle Beach, SC 29582 Phone: 843-580-1917 | |