Active NPI
D. Calvin Riley Jr. DMD PA
Doing business as Crescent Beach Dental
- Dentist
- North Myrtle Beach, SC
National Provider Identifier
1013964147
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2681
- Legal business name
- D. CALVIN RILEY JR. DMD PA
- Doing business as
- Crescent Beach Dental
- Practice address
- 602 17TH Ave So
North Myrtle Beach, SC 29582 - Phone
- (843) 272-1121
- Fax
- (843) 272-9976
- NPI assigned
- May 26, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Don Calvin Riley Jr.
- Title
- Dentist Owner
- Phone
- (843) 272-1121
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2681 | SC | Primary |
Addresses
Primary practice location
602 17TH Ave So
North Myrtle Beach, SC 29582
Mailing address
602 17TH Ave So
North Myrtle Beach, SC 29582
Phone (843) 272-1121
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ZZ2681 | Medicaid | SC | |
| ZA9478 | Medicaid | SC |
Other names 1
- Crescent Beach Dental
National Provider Directory
National Provider DirectoryLocations
602 17th Ave S
North Myrtle Beach, SC 29582
Phone (843) 272-1121
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- General Practice Dentistry
- No Myrtle Beach, SC
- NPI 1437281250
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148601600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1218499200000",
"number": "1013964147",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "602 17TH AVE SO",
"city": "NORTH MYRTLE BEACH",
"state": "SC",
"postal_code": "29582",
"telephone_number": "843-272-1121",
"fax_number": "843-272-9976"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "602 17TH AVE SO",
"city": "NORTH MYRTLE BEACH",
"state": "SC",
"postal_code": "29582",
"telephone_number": "843-272-1121",
"fax_number": "843-272-9976"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "D. CALVIN RILEY JR. DMD PA",
"organizational_subpart": "NO",
"enumeration_date": "2006-05-26",
"last_updated": "2008-08-12",
"status": "A",
"authorized_official_last_name": "RILEY",
"authorized_official_first_name": "DON",
"authorized_official_middle_name": "CALVIN",
"authorized_official_title_or_position": "DENTIST OWNER",
"authorized_official_telephone_number": "843-272-1121",
"authorized_official_name_suffix": "Jr."
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist",
"state": "SC",
"license": "2681",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "ZZ2681",
"state": "SC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "ZA9478",
"state": "SC"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Crescent Beach Dental",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in North Myrtle Beach, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.