Provider Demographics
NPI:1679671754
Name:KNIGHT, RYAN ADAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:ADAM
Last Name:KNIGHT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5720 LOCKE AVE
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107
Mailing Address - Country:US
Mailing Address - Phone:817-737-6601
Mailing Address - Fax:817-737-6446
Practice Address - Street 1:5720 LOCKE AVE
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107
Practice Address - Country:US
Practice Address - Phone:907-274-4746
Practice Address - Fax:907-274-4745
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAK1050122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX29642OtherTEXAS STATE LICENSE