Ryan A McCollum, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

D14632 Issued in MN

Practice address

2229 23Rd St NW
Bemidji, MN 56601-5503

Phone

(218) 333-6515

NPI assigned

Oct 29, 2021

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Moosecreek Dental Co

  • General Practice Dentistry
  • Bemidji, MN
  • NPI 1700747631
  NPD Authorized official
• Headwaters Dental

  • General Practice Dentistry
  • Bemidji, MN
  • NPI 1558374561
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1635465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1766966400000",
    "number": "1083378616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2229 23RD ST NW",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566015503",
            "telephone_number": "218-333-6515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2229 23RD ST NW",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566015503",
            "telephone_number": "218-333-6515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCOLLUM",
        "first_name": "RYAN",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-10-29",
        "last_updated": "2025-12-29",
        "certification_date": "2025-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D14632",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lauren Mayo, DPT
• Charles Edward McCalip
• Angela McCarthy, NP
• Merri Pearl McCarthy, MSW LICSW
• Kayla Joyce McClellan, AU.D.
• McDonald Chiropractic PLLC
• Jeffrey Andrew McDonald, DC
• Lauren McDougall
• Jennifer Dickenson McGill, PA-C
• Shannon Laurel McGrath

• Dentist in Bemidji, MN
• Providers in Bemidji, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.