Healthcare Provider Details

I. General information

NPI: 1699184648
Provider Name (Legal Business Name): RYAN T MCGARY DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2014
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4323 HILL ST
COLUMBIA SC
29207-6022
US

IV. Provider business mailing address

38717 38TH STREET BLDG
FORT GORDOM GA
30905-5660
US

V. Phone/Fax

Practice location:
  • Phone: 803-751-6209
  • Fax:
Mailing address:
  • Phone: 706-787-6927
  • Fax: 706-787-2082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number9054856-9921
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number90548569921
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number10006
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: