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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