Provider Demographics
NPI:1043598089
Name:DALTON, GLORIA (DOM AP)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:
Last Name:DALTON
Suffix:
Gender:F
Credentials:DOM AP
Other - Prefix:DR
Other - First Name:G.
Other - Middle Name:
Other - Last Name:DALTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1219 S EAST AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2355
Mailing Address - Country:US
Mailing Address - Phone:941-706-1490
Mailing Address - Fax:
Practice Address - Street 1:1219 S EAST AVE STE 202
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2355
Practice Address - Country:US
Practice Address - Phone:941-706-1490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-25
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 2988171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist