Provider Demographics
NPI:1306577283
Name:WALTON, ZACK (DMD)
Entity type:Individual
Prefix:DR
First Name:ZACK
Middle Name:
Last Name:WALTON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 E MCMURRAY BLVD
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-3616
Mailing Address - Country:US
Mailing Address - Phone:520-208-1092
Mailing Address - Fax:
Practice Address - Street 1:2010 E ELLIOT RD STE 105
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-1790
Practice Address - Country:US
Practice Address - Phone:480-360-9170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0114311223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist