Individual
RYAN P WICKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
8789 LINE AVE, SHREVEPORT, LA 71106-6813
(318) 865-1600
Mailing address
8789 LINE AVE, SHREVEPORT, LA 71106-6813
(318) 865-1600
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5526
LA
Other
Enumeration date
07/03/2006
Last updated
07/08/2007
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