Provider Demographics
NPI:1609052620
Name:WALTON, RYAN MARK (DENTIST)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:MARK
Last Name:WALTON
Suffix:
Gender:M
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 E EXCHANGE ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1865
Mailing Address - Country:US
Mailing Address - Phone:330-434-3485
Mailing Address - Fax:330-762-1600
Practice Address - Street 1:508 E EXCHANGE ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1865
Practice Address - Country:US
Practice Address - Phone:330-434-3485
Practice Address - Fax:330-762-1600
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0226011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice