Organization
RYAN O'MALLEY LLC
Active
Other names
O'Malley Dental
Organization subpart
No
Provider details
NPI number
Authorized official
IVEY LINDSAY (FORMER OM)
(864) 962-4140
Entity
Organization
Contact information
Practice address
419 SE MAIN ST, SUITE 100, SIMPSONVILLE, SC 29681-2673
(864) 962-4140
(864) 962-4142
Mailing address
419 SE MAIN ST, SUITE 100, SIMPSONVILLE, SC 29681-2673
(864) 962-4140
(864) 962-4142
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
332BC3200X
Customized Equipment (DME)
6921
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1710290663
INDIVIDUAL NPI
SC
01
—
1831503580
INDIVIDUAL NPI
—
Enumeration date
02/18/2014
Last updated
08/04/2020
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