Provider Demographics
NPI:1811910342
Name:WALTON, W. DEAN (DDS)
Entity type:Individual
Prefix:DR
First Name:W.
Middle Name:DEAN
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 1:14431 W 80TH TER
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-4111
Mailing Address - Country:US
Mailing Address - Phone:913-492-4879
Mailing Address - Fax:
Practice Address - Street 1:920 6TH AVE
Practice Address - Street 2:MEDICAL ARTS BLDG
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-3225
Practice Address - Country:US
Practice Address - Phone:913-682-2595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS47981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice