Provider Demographics
NPI:1407863574
Name:WALTON, TROY R (DDS)
Entity type:Individual
Prefix:DR
First Name:TROY
Middle Name:R
Last Name:WALTON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 696
Mailing Address - Street 2:161 EAST 550 NORTH
Mailing Address - City:MILLVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84326
Mailing Address - Country:US
Mailing Address - Phone:435-245-6390
Mailing Address - Fax:
Practice Address - Street 1:271 SPRINGCREEK PKWY STE D
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:UT
Practice Address - Zip Code:84332-9875
Practice Address - Country:US
Practice Address - Phone:435-755-6562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT59278891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice