MEDICARE: DR. DENNIS WADE 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
1	1223G0001X	General Practice Dentistry	FL 8043	FL

General Provider Information

NPI Number	:	1932232766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENNIS WADE DALTON DDS

Provider Business Mailing Address
First Line	:	4401 SE 15TH AVE
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-8649
Country	:	US
Telephone Number	:	239-549-5778
Fax Number	:	239-549-7040

Provider Business Practice Location Address
First Line	:	4401 SE 15TH AVE
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-8699
Country	:	US
Telephone Number	:	239-549-5778
Fax Number	:	239-549-5778

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

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	04/03/2019

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