Provider Demographics
NPI:1215032388
Name:DALTON, TONY J (DDS)
Entity Type:Individual
Prefix:DR
First Name:TONY
Middle Name:J
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 1:1055 RUTH ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1740
Mailing Address - Country:US
Mailing Address - Phone:928-445-5600
Mailing Address - Fax:928-778-3898
Practice Address - Street 1:1055 RUTH ST
Practice Address - Street 2:SUITE 7
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1740
Practice Address - Country:US
Practice Address - Phone:928-445-5600
Practice Address - Fax:928-778-3898
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ48571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ4857OtherDENTAL LICENSE