Active NPI
Shawn Robert Walton
- Dentist
- Sioux City, IA
National Provider Identifier
1336209188
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 07610
- Practice address
- 2410 Pierce Street
Sioux City, IA 51104 - Phone
- (712) 255-7607
- Fax
- (712) 255-4507
- NPI assigned
- Dec 11, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 07610 | IA | Primary |
Addresses
Primary practice location
2410 Pierce Street
Sioux City, IA 51104
Mailing address
2410 Pierce Street
Sioux City, IA 51104
Phone (712) 255-7607
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10025415600 | Medicaid | NE | |
| 0102343 | Medicaid | IA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 07610 | IA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165795200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1396828800000",
"number": "1336209188",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2410 PIERCE STREET",
"city": "SIOUX CITY",
"state": "IA",
"postal_code": "51104",
"telephone_number": "712-255-7607",
"fax_number": "712-255-4507"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2410 PIERCE STREET",
"city": "SIOUX CITY",
"state": "IA",
"postal_code": "51104",
"telephone_number": "712-255-7607",
"fax_number": "712-255-4507"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALTON",
"first_name": "SHAWN",
"middle_name": "ROBERT",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-11",
"last_updated": "2014-04-07",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IA",
"license": "07610",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "10025415600",
"state": "NE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0102343",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sioux City, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.