Healthcare Provider Details

I. General information

NPI: 1720229438
Provider Name (Legal Business Name): PATRICK E DAULTON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2009
Last Update Date: 03/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 ELMORE AVE
COLUMBUS OH
43224-2722
US

IV. Provider business mailing address

1400 ELMORE AVE
COLUMBUS OH
43224-2722
US

V. Phone/Fax

Practice location:
  • Phone: 614-262-1237
  • Fax:
Mailing address:
  • Phone: 614-262-1237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.015417
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: