MEDICARE: DR. RYAN ADEL ABDULLAH DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	10535	SC

General Provider Information

NPI Number	:	1306525308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN ADEL ABDULLAH DMD

Provider Business Mailing Address
First Line	:	412 YELLOW FOX RD
Second Line	:
City	:	GREER
State	:	SC
Zip	:	29650-4695
Country	:	US
Telephone Number	:	843-737-1145
Fax Number	:

Provider Business Practice Location Address
First Line	:	2800 WOODRUFF RD
Second Line	:
City	:	SIMPSONVILLE
State	:	SC
Zip	:	29681-4806
Country	:	US
Telephone Number	:	864-963-7000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2023
Last Update Date	:	07/17/2023

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