Provider Demographics
NPI:1669451910
Name:WALTON, ROBERT A (GENERAL DENTIST)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:WALTON
Suffix:
Gender:M
Credentials:GENERAL DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8003 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-2229
Mailing Address - Country:US
Mailing Address - Phone:330-856-4888
Mailing Address - Fax:330-856-2428
Practice Address - Street 1:8003 E MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-2229
Practice Address - Country:US
Practice Address - Phone:330-856-4888
Practice Address - Fax:330-856-2428
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH152261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice