Healthcare Provider Details

I. General information

NPI: 1356267389
Provider Name (Legal Business Name): DR. DALE & CO. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 WIMBLEDON DR APT 6
BRANSON MO
65616-3864
US

IV. Provider business mailing address

305 WIMBLEDON DR APT 6
BRANSON MO
65616-3864
US

V. Phone/Fax

Practice location:
  • Phone: 904-809-0395
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name: DALE JUNIOR SMITH
Title or Position: OWNER
Credential:
Phone: 904-809-0395