Basic Information
| Provider Information | |||||||||
| NPI: | 1083970685 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DALTON | ||||||||
| FirstName: | MICHAEL | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2860 MICHELLE DRIVE | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7143682077 | ||||||||
| FaxNumber: | 7143682092 | ||||||||
| Practice Location | |||||||||
| Address1: | 13616 POWAY RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | POWAY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920646548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8583919300 | ||||||||
| FaxNumber: | 8583919449 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2012 | ||||||||
| LastUpdateDate: | 04/09/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 38826 | CA | Y | Dental Providers | Dentist |
No ID Information.