Provider Demographics
NPI:1003020058
Name:WALTON, WILLIAM MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:MICHAEL
Last Name:WALTON
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:PO BOX 481
Mailing Address - Street 2:113 HUNT
Mailing Address - City:CLYDE
Mailing Address - State:TX
Mailing Address - Zip Code:79510-0481
Mailing Address - Country:US
Mailing Address - Phone:325-893-5875
Mailing Address - Fax:325-893-5876
Practice Address - Street 1:113 HUNT STREET
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:TX
Practice Address - Zip Code:79510
Practice Address - Country:US
Practice Address - Phone:325-893-5875
Practice Address - Fax:325-893-5876
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11233122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist