Provider Demographics
NPI:1194028100
Name:DALTON, TERESA D
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:D
Last Name:DALTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-9664
Mailing Address - Country:US
Mailing Address - Phone:307-763-6306
Mailing Address - Fax:
Practice Address - Street 1:33 EAGLE DR
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-9664
Practice Address - Country:US
Practice Address - Phone:307-763-6306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management