Provider Demographics
NPI:1881144897
Name:RYAN W. WALTER D.M.D.
Entity type:Organization
Organization Name:RYAN W. WALTER D.M.D.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:WALTER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-841-6159
Mailing Address - Street 1:835 BELVIDERE RD
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-1384
Mailing Address - Country:US
Mailing Address - Phone:908-859-4555
Mailing Address - Fax:
Practice Address - Street 1:835 BELVIDERE RD
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-1384
Practice Address - Country:US
Practice Address - Phone:908-859-4555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI025865041223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty