Organization
AZALEA DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS PATRICK RILEY DMD (DENTIST AND OWNER)
(843) 261-9754
Entity
Organization
Contact information
Practice address
310 N GUM ST STE B, SUMMERVILLE, SC 29483-6874
(843) 216-9754
(843) 216-9756
Mailing address
310 N GUM ST STE B, SUMMERVILLE, SC 29483-6874
(843) 216-9754
(843) 216-9756
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3580
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZX03580
—
SC
Enumeration date
05/15/2007
Last updated
07/17/2007
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