MEDICARE: DR. DAVID KIMBALL WALTON DDS, MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0300X	Periodontics	9031	CO

General Provider Information

NPI Number	:	1003886995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID KIMBALL WALTON DDS, MS

Provider Business Mailing Address
First Line	:	4026 S TIMBERLINE RD UNIT 120
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-6024
Country	:	US
Telephone Number	:	970-482-2210
Fax Number	:	970-482-2208

Provider Business Practice Location Address
First Line	:	4026 S TIMBERLINE RD UNIT 120
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-6024
Country	:	US
Telephone Number	:	970-482-2210
Fax Number	:	970-482-2208

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	06/28/2012

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