Provider Demographics
NPI:1255517082
Name:GILREATH, RYAN N (DMD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:N
Last Name:GILREATH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 38
Mailing Address - Street 2:122 A SOUTH GOOSE CREEK BLVD
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-0038
Mailing Address - Country:US
Mailing Address - Phone:843-764-3081
Mailing Address - Fax:843-764-7947
Practice Address - Street 1:122 S GOOSE CREEK BLVD
Practice Address - Street 2:A
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-3136
Practice Address - Country:US
Practice Address - Phone:843-764-3081
Practice Address - Fax:843-764-7947
Is Sole Proprietor?:No
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC43691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice