Provider Demographics
NPI:1447239330
Name:RIKER, KEVIN R (DDS)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:R
Last Name:RIKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 SAVANNAH HWY
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-7806
Mailing Address - Country:US
Mailing Address - Phone:843-402-0400
Mailing Address - Fax:843-402-0550
Practice Address - Street 1:1112 SAVANNAH HWY
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7806
Practice Address - Country:US
Practice Address - Phone:843-402-0400
Practice Address - Fax:843-402-0550
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3284 0440 OS1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ32843Medicaid
SCZ32843Medicaid