Active NPI
Ryan McCormack, DDS
- General Practice Dentistry
- Columbia, MD
National Provider Identifier
1487252698
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 17200
- Practice address
- 5410 Lynx LN Ste 290
Columbia, MD 21044-2483 - Phone
- (410) 910-9716
- NPI assigned
- Oct 12, 2020
- Last updated
- Oct 12, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 17200 | MD | Primary |
Addresses
Primary practice location
5410 Lynx LN Ste 290
Columbia, MD 21044-2483
Mailing address
2809 Boston St Apt 134
Baltimore, MD 21224-4881
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17200 | MD | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dynamic Dental Care, LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1602460800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1602460800000",
"number": "1487252698",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2809 BOSTON ST APT 134",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212244881"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5410 LYNX LN STE 290",
"city": "COLUMBIA",
"state": "MD",
"postal_code": "210442483",
"telephone_number": "410-910-9716"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCORMACK",
"first_name": "RYAN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-10-12",
"last_updated": "2020-10-12",
"certification_date": "2020-10-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MD",
"license": "17200",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbia, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.