Provider Demographics
NPI:1003211772
Name:RYAN WALKER DDS PLLC
Entity Type:Organization
Organization Name:RYAN WALKER DDS PLLC
Other - Org Name:SAMMAMISH PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-999-5941
Mailing Address - Street 1:336 228TH AVE NE
Mailing Address - Street 2:STE 301
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98074-7289
Mailing Address - Country:US
Mailing Address - Phone:206-999-5941
Mailing Address - Fax:
Practice Address - Street 1:336 228TH AVE NE
Practice Address - Street 2:STE 301
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98074-7289
Practice Address - Country:US
Practice Address - Phone:206-999-5941
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 601402591223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty