Active NPI
Raymond E Cleary III, DDS
- General Practice Dentistry
- Surfside Beach, SC
National Provider Identifier
1134493141
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 1878
- Practice address
- 1625 Glenns Bay Rd
Surfside Beach, SC 29575-4836 - Phone
- (843) 650-5100
- Fax
- (843) 650-0689
- NPI assigned
- Mar 8, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 1878 | SC | Primary |
Addresses
Primary practice location
1625 Glenns Bay Rd
Surfside Beach, SC 29575-4836
Mailing address
1625 Glenns Bay Rd
Surfside Beach, SC 29575-4836
Phone (843) 650-5100
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1878 | SC | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1331164800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1331164800000",
"number": "1134493141",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1625 GLENNS BAY RD",
"city": "SURFSIDE BEACH",
"state": "SC",
"postal_code": "295754836",
"telephone_number": "843-650-5100",
"fax_number": "843-650-0689"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1625 GLENNS BAY RD",
"city": "SURFSIDE BEACH",
"state": "SC",
"postal_code": "295754836",
"telephone_number": "843-650-5100",
"fax_number": "843-650-0689"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLEARY",
"first_name": "RAYMOND",
"middle_name": "E",
"name_suffix": "III",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-03-08",
"last_updated": "2012-03-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "SC",
"license": "1878",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Surfside Beach, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.