Provider Demographics
NPI:1174839674
Name:B. RYAN FLEMING, DDS, PA
Entity Type:Organization
Organization Name:B. RYAN FLEMING, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUS MGR
Authorized Official - Prefix:
Authorized Official - First Name:JANELL
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-722-8500
Mailing Address - Street 1:14 LOCKWOOD DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29401-1126
Mailing Address - Country:US
Mailing Address - Phone:843-722-8500
Mailing Address - Fax:843-720-8555
Practice Address - Street 1:14 LOCKWOOD DR
Practice Address - Street 2:SUITE A
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-1126
Practice Address - Country:US
Practice Address - Phone:843-722-8500
Practice Address - Fax:843-720-8555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-23
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4689122300000X
SC1313122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX-4689Medicaid
SCZ-1313Medicaid