Healthcare Provider Details

I. General information

NPI: 1679658876
Provider Name (Legal Business Name): RYAN MITCHELL WALKER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 N 36TH ST SUITE C
SAINT JOSEPH MO
64506-2970
US

IV. Provider business mailing address

803 N 36TH ST SUITE C
SAINT JOSEPH MO
64506-2970
US

V. Phone/Fax

Practice location:
  • Phone: 816-364-4422
  • Fax: 816-364-1122
Mailing address:
  • Phone: 816-364-4422
  • Fax: 816-364-1122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number2003011564
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: