Provider Demographics
NPI:1386684421
Name:DALTON, HILARY RAE (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:HILARY
Middle Name:RAE
Last Name:DALTON
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4148 SALTWATER BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-5633
Mailing Address - Country:US
Mailing Address - Phone:813-500-5642
Mailing Address - Fax:813-254-2112
Practice Address - Street 1:6025 MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-4531
Practice Address - Country:US
Practice Address - Phone:813-886-2527
Practice Address - Fax:813-887-3225
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX195751223P0300X
FLDN 149761223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics