Active NPI
Paul Coleman Riley Jr., D.D.S.
- Endodontics
- Lake Charles, LA
National Provider Identifier
1326490673
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 6681
- Practice address
- 636 W McNeese St
Lake Charles, LA 70605-5558 - Phone
- (601) 862-8586
- NPI assigned
- Jul 11, 2016
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 6681 | LA | Primary |
Addresses
Primary practice location
636 W McNeese St
Lake Charles, LA 70605-5558
Mailing address
636 W McNeese St
Lake Charles, LA 70605-5558
Phone (601) 862-8586
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in LA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200826000918 | LA | Order and Referring Only - Dentist | 7911324686 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1468195200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695945600000",
"number": "1326490673",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "636 W MCNEESE ST",
"city": "LAKE CHARLES",
"state": "LA",
"postal_code": "706055558",
"telephone_number": "601-862-8586"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "636 W MCNEESE ST",
"city": "LAKE CHARLES",
"state": "LA",
"postal_code": "706055558",
"telephone_number": "601-862-8586"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RILEY",
"first_name": "PAUL",
"middle_name": "COLEMAN",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-07-11",
"last_updated": "2023-09-29",
"certification_date": "2023-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist, Endodontics",
"state": "LA",
"license": "6681",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Charles, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.