=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689788366
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RYAN, JAMES, WILES, PATEL & OLSEN LLP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2006
-----------------------------------------------------
Last Update Date | 10/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 312 W MCLEAN ST
-----------------------------------------------------
City | SAINT PAULS
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28384-1726
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-865-5188
-----------------------------------------------------
Fax | 910-865-3015
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 365
-----------------------------------------------------
City | SAINT PAULS
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28384-0365
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-865-5188
-----------------------------------------------------
Fax | 910-865-3015
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | REVENUE CYCLE DIRECTOR
-----------------------------------------------------
Name | CHRISTINA C PATE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 910-484-7070
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------