Provider Demographics
NPI:1376502898
Name:DALTON, LAURA (M D)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:DALTON
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 MILITARY W
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-2451
Mailing Address - Country:US
Mailing Address - Phone:707-745-0711
Mailing Address - Fax:707-745-0788
Practice Address - Street 1:1440 MILITARY W
Practice Address - Street 2:SUITE 101
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-2451
Practice Address - Country:US
Practice Address - Phone:707-745-0711
Practice Address - Fax:707-745-0788
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA73467207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH85294Medicare UPIN