=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619302064
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHRISTOPHER J WALTON DDS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/04/2013
-----------------------------------------------------
Last Update Date | 09/04/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1161 SW WILSHIRE BLVD SUITE 110
-----------------------------------------------------
City | BURLESON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76028-5707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-447-7474
-----------------------------------------------------
Fax | 817-447-4306
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1161 SW WILSHIRE BLVD SUITE 110
-----------------------------------------------------
City | BURLESON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76028-5707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-447-7474
-----------------------------------------------------
Fax | 817-447-4306
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DOCTOR
-----------------------------------------------------
Name | DR. CHRISTOPHER WALTON
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 817-447-7474
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | 26063
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------