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Organization
RYAN P. MACRAE, LLC
Active
Organization
RYAN P. MACRAE, LLC
Active
Other names
Mountain Lakes Family Dentstry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RYAN PATRICK MACRAE DMD (DENTIST-OWNER)
(864) 722-9255
Entity
Organization
Contact information
Practice address
635 OLD GREENVILLE HWY, CLEMSON, SC 29631-1219
(864) 722-9255
Mailing address
635 OLD GREENVILLE HWY, CLEMSON, SC 29631-1219
(864) 722-9255
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4031
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2X4031
—
SC
01
—
4031
LICENSE#
SC
Enumeration date
10/27/2011
Last updated
03/07/2023
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