Provider Demographics
NPI:1679658876
Name:WALKER, RYAN MITCHELL (DDS)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:MITCHELL
Last Name:WALKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:803 N 36TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-2970
Mailing Address - Country:US
Mailing Address - Phone:816-364-4422
Mailing Address - Fax:816-364-1122
Practice Address - Street 1:803 N 36TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-2970
Practice Address - Country:US
Practice Address - Phone:816-364-4422
Practice Address - Fax:816-364-1122
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO20030115641223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO33866024OtherBLUE CROSS & BLUE SHIELD
11564OtherDELTA DENTAL