Provider Demographics
NPI:1417128174
Name:DALTON DENTAL SERVICES, INC
Entity Type:Organization
Organization Name:DALTON DENTAL SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/GENERAL PRACTICE
Authorized Official - Prefix:DR
Authorized Official - First Name:PAT
Authorized Official - Middle Name:R
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:706-260-6032
Mailing Address - Street 1:318 ORCHARD WAY SE
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-4587
Mailing Address - Country:US
Mailing Address - Phone:706-260-6032
Mailing Address - Fax:
Practice Address - Street 1:1020 CHATTANOOGA AVE
Practice Address - Street 2:STE D
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-8880
Practice Address - Country:US
Practice Address - Phone:706-277-1671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0103391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty