Individual
MR. SHAWN ROBERT WALTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2410 PIERCE STREET, SIOUX CITY, IA 51104
(712) 255-7607
(712) 255-4507
Mailing address
2410 PIERCE STREET, SIOUX CITY, IA 51104
(712) 255-7607
(712) 255-4507
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
07610
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0102343
—
IA
05
—
10025415600
—
NE
Enumeration date
12/11/2006
Last updated
04/07/2014
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