Active NPI
Raynard Otis Riley, DDS
- Dentist
- Summit, NJ
National Provider Identifier
1811390230
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 22D102143400
- Practice address
- 475 Springfield Ave
Suite 210
Summit, NJ 07901 - Phone
- (908) 273-5656
- Fax
- (908) 273-5661
- NPI assigned
- Sep 30, 2014
- Last updated
- Sep 30, 2014
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 22D102143400 | NJ | Primary |
Addresses
Primary practice location
475 Springfield Ave
Suite 210
Summit, NJ 07901
Mailing address
475 Springfield Ave
Suite 210
Summit, NJ 07901
Phone (908) 273-5656
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 |
|---|---|---|---|
| 22D102143400 | NJ | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Raynard Riley DDS | Dentist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1412035200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1412035200000",
"number": "1811390230",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "475 SPRINGFIELD AVE",
"address_2": "SUITE 210",
"city": "SUMMIT",
"state": "NJ",
"postal_code": "07901",
"telephone_number": "908-273-5656",
"fax_number": "908-273-5661"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "475 SPRINGFIELD AVE",
"address_2": "SUITE 210",
"city": "SUMMIT",
"state": "NJ",
"postal_code": "07901",
"telephone_number": "908-273-5656",
"fax_number": "908-273-5661"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RILEY",
"first_name": "RAYNARD",
"middle_name": "OTIS",
"name_prefix": "Mr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-09-30",
"last_updated": "2014-09-30",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NJ",
"license": "22D102143400",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Summit, NJ
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- Samantha Rivera, MD
- Ilya Rivkin, PMHNP
- Laurie M Robbins, LCSW
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.