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General NPI Number Information
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NPI Number | 1396186292
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Entity Type | Individual
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Provider Name | RYAN BROOKS MCMAHAN DDS. MS
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Gender | Male
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Dates
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Enumeration Date | 07/09/2013
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Last Update Date | 01/31/2019
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Provider Practice Location Address
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Address Line | 400 W MAIN ST STE 106
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City | GAYLORD
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State | MI
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Zip | 49735-1870
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Country | US
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Telephone | 989-731-6741
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Fax | 989-731-5235
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Provider Business Mailing Address
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Address Line | 400 W MAIN ST STE 106
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City | GAYLORD
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State | MI
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Zip | 49735-1870
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Country | US
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Telephone | 989-731-6741
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Fax | 989-731-5235
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 2901020951
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2901020951
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License Number State | MI
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