Provider Demographics
NPI:1467509471
Name:COLBURN, RYAN J (DDS)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:J
Last Name:COLBURN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 JOHN B WHITE SR BLVD # A
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29306-3927
Mailing Address - Country:US
Mailing Address - Phone:864-574-5297
Mailing Address - Fax:864-576-6833
Practice Address - Street 1:1410 JOHN B WHITE SR BLVD # A
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29306-3927
Practice Address - Country:US
Practice Address - Phone:864-574-5297
Practice Address - Fax:864-576-6833
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC39851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice