Provider Demographics
NPI:1932232766
Name:DALTON, DENNIS WADE (DDS)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:WADE
Last Name:DALTON
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 1:4401 SE 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-8649
Mailing Address - Country:US
Mailing Address - Phone:239-549-5778
Mailing Address - Fax:239-549-7040
Practice Address - Street 1:4401 SE 15TH AVE
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-8699
Practice Address - Country:US
Practice Address - Phone:239-549-5778
Practice Address - Fax:239-549-5778
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL 80431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice