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NPI Code Detail

MEDICARE: MICHAEL J DALTON DDS

MEDICARE: MICHAEL J DALTON DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223S0112XOral and Maxillofacial Surgery (Dentist)07440IA
21223S0112XOral and Maxillofacial Surgery (Dentist)4162015WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
229887OTHERIABCBS-DELTA DENTAL OF IA
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1124012059
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL J DALTON DDS
Provider Business Mailing Address
First Line : 100 BRYANT ST
Second Line :
City : DUBUQUE
State : IA
Zip : 52003-7405
Country : US
Telephone Number : 563-557-1440
Fax Number : 563-557-7001
Provider Business Practice Location Address
First Line : 100 BRYANT ST
Second Line :
City : DUBUQUE
State : IA
Zip : 52003-7405
Country : US
Telephone Number : 563-557-1440
Fax Number : 563-557-7001
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/07/2005
Last Update Date : 07/08/2007

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Directions to “ MICHAEL J DALTON DDS” Practice Location

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