Provider Demographics
NPI:1053608935
Name:HUKILL, RYAN KEITH (DDS)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:KEITH
Last Name:HUKILL
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 1:3041 SENNA DR
Mailing Address - Street 2:
Mailing Address - City:MATTEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105
Mailing Address - Country:US
Mailing Address - Phone:704-321-7929
Mailing Address - Fax:
Practice Address - Street 1:3041 SENNA DR
Practice Address - Street 2:
Practice Address - City:MATTEWS
Practice Address - State:NC
Practice Address - Zip Code:28105
Practice Address - Country:US
Practice Address - Phone:704-321-7929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL2029268122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist