Provider Demographics
NPI:1992093900
Name:KARI RYAN DENTISTRY PA
Entity type:Organization
Organization Name:KARI RYAN DENTISTRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-881-1638
Mailing Address - Street 1:815 LOWCOUNTRY BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3024
Mailing Address - Country:US
Mailing Address - Phone:843-881-1638
Mailing Address - Fax:
Practice Address - Street 1:815 LOWCOUNTRY BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3024
Practice Address - Country:US
Practice Address - Phone:843-881-1638
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KARI RYAN DENTISTRY PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-12
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6906122300000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty