Provider Demographics
NPI:1508279506
Name:BARRETT, RYAN
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:BARRETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 WOODS BAY CT
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-3745
Mailing Address - Country:US
Mailing Address - Phone:718-208-7074
Mailing Address - Fax:
Practice Address - Street 1:516 WOODS BAY CT
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-3745
Practice Address - Country:US
Practice Address - Phone:718-208-7074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-06
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058448122300000X
NC13188122300000X
390200000X
SC10364122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program