Provider Demographics
NPI:1922270073
Name:WALKER, RYAN JEFFERY (DDS)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:JEFFERY
Last Name:WALKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 228TH AVE NE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98074-7289
Mailing Address - Country:US
Mailing Address - Phone:425-466-5210
Mailing Address - Fax:425-642-8017
Practice Address - Street 1:336 228TH AVE NE
Practice Address - Street 2:SUITE 301
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98074-7289
Practice Address - Country:US
Practice Address - Phone:425-466-5210
Practice Address - Fax:425-642-8017
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-28
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE601402591223P0221X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program