Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 9031 | CO |
NPI | 1003886995 |
---|---|
Provider Name | Dr. David Kimball Walton |
First Address | Fort Collins, CO 80525-6024 |
Second Address | Fort Collins, CO 80525-6024 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2006 |
Last Update Date | 28/06/2012 |