Healthcare Provider Details

I. General information

NPI: 1790642577
Provider Name (Legal Business Name): EMILY DALTON
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2364 W 12600 S
RIVERTON UT
84065-7109
US

IV. Provider business mailing address

12191 S PARK HAVEN LN
RIVERTON UT
84096-7314
US

V. Phone/Fax

Practice location:
  • Phone: 385-212-4824
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number14239607-1103
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: