Provider Demographics
NPI:1356771927
Name:PHILLIPS, RYAN (DMD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 BRYANT ST
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:SC
Mailing Address - Zip Code:29477-2160
Mailing Address - Country:US
Mailing Address - Phone:843-563-3208
Mailing Address - Fax:843-563-7800
Practice Address - Street 1:102 BRYANT ST
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:SC
Practice Address - Zip Code:29477-2160
Practice Address - Country:US
Practice Address - Phone:843-563-3208
Practice Address - Fax:843-563-7800
Is Sole Proprietor?:No
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC82761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice