Individual
DR. MARTIN LUTHER WALTON III
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
521 N 11TH ST, PED. DENT. VCU SCHOOL OF DENTISTRY, RICHMOND, VA 23298-5045
(804) 828-0791
(804) 827-0163
Mailing address
PO BOX 980566, PED. DENT. VCU SCHOOL OF DENTISTRY, RICHMOND, VA 23298-0566
(804) 828-0791
(804) 827-0163
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
0401008399
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0007101
DORAL
VA
05
—
78-0361-3
—
VA
Enumeration date
10/12/2005
Last updated
07/08/2007
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