Healthcare Provider Details

I. General information

NPI: 1295816197
Provider Name (Legal Business Name): ELIZABETH GRACE WALTON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3540 W CAMELBACK RD
PHOENIX AZ
85019-2707
US

IV. Provider business mailing address

3030 N CENTRAL AVE STE 1500
PHOENIX AZ
85012-2750
US

V. Phone/Fax

Practice location:
  • Phone: 602-427-4070
  • Fax: 602-427-4063
Mailing address:
  • Phone: 602-427-4066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD010963
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: