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Organization
PICKENS FAMILY DENTISTRY LLC
Active
Organization
PICKENS FAMILY DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN PATRICK MACRAE DMD (OWNER-PRESIDENT)
(864) 878-3501
Entity
Organization
Contact information
Practice address
829 PENDLETON ST, PICKENS, SC 29671-2578
(864) 878-3501
(864) 878-3502
Mailing address
829 PENDLETON ST, PICKENS, SC 29671-2578
(864) 878-3501
(864) 878-3502
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4031
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1407947534
NPI
SC
Enumeration date
12/14/2015
Last updated
12/14/2015
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