Healthcare Provider Details

I. General information

NPI: 1992093900
Provider Name (Legal Business Name): KARI RYAN DENTISTRY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2011
Last Update Date: 12/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 LOWCOUNTRY BLVD
MOUNT PLEASANT SC
29464-3024
US

IV. Provider business mailing address

815 LOWCOUNTRY BLVD
MOUNT PLEASANT SC
29464-3024
US

V. Phone/Fax

Practice location:
  • Phone: 843-881-1638
  • Fax:
Mailing address:
  • Phone: 843-881-1638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6906
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. KARI ANN RYAN
Title or Position: OWNER
Credential: D.M.D.
Phone: 843-881-1638