Provider Demographics
NPI:1194838102
Name:DAULTON, JEFFREY S (DDS)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:S
Last Name:DAULTON
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 1:39400 GARFIELD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-4096
Mailing Address - Country:US
Mailing Address - Phone:586-286-0700
Mailing Address - Fax:586-286-5969
Practice Address - Street 1:39400 GARFIELD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-4096
Practice Address - Country:US
Practice Address - Phone:586-286-0700
Practice Address - Fax:586-286-5969
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI160541223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3499500Medicaid