Provider Demographics
NPI:1528261682
Name:ALTO, DALE L (DDS)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:L
Last Name:ALTO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 N ACADEMY BLVD
Mailing Address - Street 2:SUITE 213
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80916
Mailing Address - Country:US
Mailing Address - Phone:719-597-4060
Mailing Address - Fax:719-574-2140
Practice Address - Street 1:3100 N ACADEMY BLVD
Practice Address - Street 2:SUITE 213
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-5321
Practice Address - Country:US
Practice Address - Phone:719-597-4060
Practice Address - Fax:719-574-2140
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9675122300000X
OH2403204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO34054022Medicaid