Provider Demographics
NPI:1699774729
Name:WALTON, GERALD E (DDS)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:E
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 1:5604 NE ANTIOCH RD
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:MO
Mailing Address - Zip Code:64119-2378
Mailing Address - Country:US
Mailing Address - Phone:816-453-9600
Mailing Address - Fax:816-453-9600
Practice Address - Street 1:5604 NE ANTIOCH RD
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:MO
Practice Address - Zip Code:64119-2378
Practice Address - Country:US
Practice Address - Phone:816-453-9600
Practice Address - Fax:816-453-9600
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0129441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO08309017OtherBLUE CROSS/BLUE SHIELD