Provider Demographics
NPI:1285909010
Name:SMITH, RYAN RICHARDSON (DMD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:RICHARDSON
Last Name:SMITH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:210 VILLAGE CENTER BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-6706
Mailing Address - Country:US
Mailing Address - Phone:843-236-7500
Mailing Address - Fax:843-236-7550
Practice Address - Street 1:210 VILLAGE CENTER BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-6706
Practice Address - Country:US
Practice Address - Phone:843-236-7500
Practice Address - Fax:843-236-7550
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-13
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDGD.7093 GD1223G0001X
SC791 PD1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice