Provider Demographics
NPI:1962122093
Name:MATTHEW R WALTON DDS, LLC
Entity type:Organization
Organization Name:MATTHEW R WALTON DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-885-7006
Mailing Address - Street 1:488 S STATE ROAD 135
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-1424
Mailing Address - Country:US
Mailing Address - Phone:317-885-7006
Mailing Address - Fax:317-885-7099
Practice Address - Street 1:488 S STATE ROAD 135
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-1424
Practice Address - Country:US
Practice Address - Phone:317-885-7006
Practice Address - Fax:317-885-7099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-30
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty