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General NPI Number Information
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NPI Number | 1831667716
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Entity Type | Individual
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Provider Name | BRYAN HENRY DALTON
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Gender | Male
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Dates
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Enumeration Date | 11/08/2018
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Last Update Date | 11/08/2018
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Provider Practice Location Address
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Address Line | 539 CHAMPION RD # 4
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City | JEFFERSONVILLE
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State | IN
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Zip | 47130-7706
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Country | US
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Telephone | 181-278-6908
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Fax |
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Provider Business Mailing Address
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Address Line | 4231 ROYAL OAK DR
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City | NEW ALBANY
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State | IN
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Zip | 47150-9789
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Country | US
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Telephone | 182-786-9082
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171WH0202X
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Taxonomy Name | Home Modifications Contractor
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License Number |
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License Number State |
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