Provider Demographics
NPI:1770755464
Name:MARY WALTON DDS, MS
Entity type:Organization
Organization Name:MARY WALTON DDS, MS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FOXX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-249-4900
Mailing Address - Street 1:1505 SW CARY PARKWAY
Mailing Address - Street 2:STE 207
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511
Mailing Address - Country:US
Mailing Address - Phone:919-249-4900
Mailing Address - Fax:
Practice Address - Street 1:1505 SW CARY PKWY
Practice Address - Street 2:STE. 207
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6219
Practice Address - Country:US
Practice Address - Phone:919-249-4900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC56461223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty