Healthcare Provider Details

I. General information

NPI: 1023058443
Provider Name (Legal Business Name): DALTON CHARLES ALLEN, JR. D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 03/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13301 PARTRIDGE DR
SILVER SPRING MD
20904-1327
US

IV. Provider business mailing address

13301 PARTRIDGE DR
SILVER SPRING MD
20904-1327
US

V. Phone/Fax

Practice location:
  • Phone: 301-384-5457
  • Fax:
Mailing address:
  • Phone: 301-384-5457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2575
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: