Provider Demographics
NPI:1528096286
Name:DALTON, SCOTT L (DDS)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:L
Last Name:DALTON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:SCOTT
Other - Middle Name:L
Other - Last Name:DALTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2629 W ORANGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-6874
Mailing Address - Country:US
Mailing Address - Phone:602-864-5558
Mailing Address - Fax:602-864-2451
Practice Address - Street 1:2629 W ORANGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-6874
Practice Address - Country:US
Practice Address - Phone:602-864-7400
Practice Address - Fax:602-864-1570
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD40131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ381260Medicaid