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General NPI Number Information
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NPI Number | 1659482206
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Entity Type | Organization
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Legal Business Name | SHAWN R WALTON
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2928 HAMILTON BLVD SUITE 102
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City | SIOUX CITY
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State | IA
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Zip | 51104
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Country | US
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Telephone | 712-255-7607
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Fax | 712-255-4507
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Provider Business Mailing Address
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Address Line | 2928 HAMILTON BLVD SUITE 102
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City | SIOUX CITY
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State | IA
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Zip | 51104
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Country | US
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Telephone | 712-255-7607
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Fax | 712-255-4507
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Authorized Official
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Title or Position | DENTIST
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Name | DR. SHAWN R WALTON
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Credential | DDS
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Telephone | 712-255-7607
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 08441
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 07610
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License Number State | IA
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