Healthcare Provider Details

I. General information

NPI: 1306525308
Provider Name (Legal Business Name): RYAN ADEL ABDULLAH DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 WOODRUFF RD
SIMPSONVILLE SC
29681-4806
US

IV. Provider business mailing address

412 YELLOW FOX RD
GREER SC
29650-4695
US

V. Phone/Fax

Practice location:
  • Phone: 864-963-7000
  • Fax:
Mailing address:
  • Phone: 843-737-1145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number10535
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10535
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: