Individual
DERRIK PORTER WALTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1525 BLEISTEIN AVE, CODY, WY 82414-3806
(307) 587-2951
(307) 587-2760
Mailing address
1525 BLEISTEIN AVE, CODY, WY 82414-3806
(307) 587-2951
(307) 587-2760
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1008
WY
Other
Enumeration date
09/25/2006
Last updated
07/09/2007
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