MEDICARE: EMILY DALTON

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
1	207N00000X	Dermatology Physician	14239607-1103	UT

General Provider Information

NPI Number	:	1790642577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY DALTON

Provider Business Mailing Address
First Line	:	12191 S PARK HAVEN LN
Second Line	:
City	:	RIVERTON
State	:	UT
Zip	:	84096-7314
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2364 W 12600 S
Second Line	:
City	:	RIVERTON
State	:	UT
Zip	:	84065-7109
Country	:	US
Telephone Number	:	385-212-4824
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2026
Last Update Date	:	01/05/2026

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Directions to “ EMILY DALTON ” Practice Location

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