Healthcare Provider Details

I. General information

NPI: 1861141251
Provider Name (Legal Business Name): DAKOTA ALBERT DALTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1627 W BIG BEAVER RD
TROY MI
48084-3501
US

IV. Provider business mailing address

1627 W BIG BEAVER RD
TROY MI
48084-3501
US

V. Phone/Fax

Practice location:
  • Phone: 248-220-1560
  • Fax: 248-220-1563
Mailing address:
  • Phone: 248-220-1560
  • Fax: 248-220-1563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberU9887
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: