Provider Demographics
NPI:1669824892
Name:WELKER, RYAN
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:WELKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:MONTOURSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17754-1802
Mailing Address - Country:US
Mailing Address - Phone:570-447-2088
Mailing Address - Fax:
Practice Address - Street 1:426 CHERRY ST
Practice Address - Street 2:
Practice Address - City:MONTOURSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17754-1802
Practice Address - Country:US
Practice Address - Phone:570-447-2088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS040961122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist