Provider Demographics
NPI:1396186292
Name:MCMAHAN, RYAN BROOKS (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:BROOKS
Last Name:MCMAHAN
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:400 W MAIN ST STE 106
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-1870
Mailing Address - Country:US
Mailing Address - Phone:989-731-6741
Mailing Address - Fax:989-731-5235
Practice Address - Street 1:400 W MAIN ST STE 106
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-1870
Practice Address - Country:US
Practice Address - Phone:989-731-6741
Practice Address - Fax:989-731-5235
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-09
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010209511223E0200X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty