Healthcare Provider Details

I. General information

NPI: 1003021692
Provider Name (Legal Business Name): GARY DALTON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 11/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S SCHOOL ST
DERMOTT AR
71638-2127
US

IV. Provider business mailing address

PO BOX 509
DERMOTT AR
71638-0509
US

V. Phone/Fax

Practice location:
  • Phone: 870-538-9720
  • Fax: 870-538-3710
Mailing address:
  • Phone: 870-538-5414
  • Fax: 870-538-5412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3627
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: