Provider Demographics
NPI:1689137598
Name:WALTON, DAVIS BEARD (DDS)
Entity Type:Individual
Prefix:
First Name:DAVIS
Middle Name:BEARD
Last Name:WALTON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 US 61
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-4921
Mailing Address - Country:US
Mailing Address - Phone:601-870-0304
Mailing Address - Fax:
Practice Address - Street 1:207 SERIO BLVD
Practice Address - Street 2:
Practice Address - City:FERRIDAY
Practice Address - State:LA
Practice Address - Zip Code:71334-2014
Practice Address - Country:US
Practice Address - Phone:318-757-4561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-08
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4074-191223G0001X
LA69691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice