Provider Demographics
NPI:1740374628
Name:WALKER, RYAN ANTHONY (DDS)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:ANTHONY
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 1:27 AMARILLO DR
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-7261
Mailing Address - Country:US
Mailing Address - Phone:985-226-4625
Mailing Address - Fax:
Practice Address - Street 1:1092 VALHI BLVD
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-5980
Practice Address - Country:US
Practice Address - Phone:985-851-1633
Practice Address - Fax:985-851-1649
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA57451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice