Provider Demographics
NPI:1891241303
Name:WALTON, KAYCEE (DMD)
Entity Type:Individual
Prefix:DR
First Name:KAYCEE
Middle Name:
Last Name:WALTON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:KAYCEE
Other - Middle Name:CAROL
Other - Last Name:DEJONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5855 W UTOPIA RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-5251
Mailing Address - Country:US
Mailing Address - Phone:623-806-7167
Mailing Address - Fax:
Practice Address - Street 1:5855 W UTOPIA RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-5251
Practice Address - Country:US
Practice Address - Phone:623-806-7167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-26
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0095791223X0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0008XDental ProvidersDentistOral and Maxillofacial Radiology