Provider Demographics
NPI:1508126889
Name:DALTON, VANDANA (MD)
Entity Type:Individual
Prefix:DR
First Name:VANDANA
Middle Name:
Last Name:DALTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 GRAVOIS RD
Mailing Address - Street 2:STE 115
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-7723
Mailing Address - Country:US
Mailing Address - Phone:314-543-6985
Mailing Address - Fax:
Practice Address - Street 1:714 GRAVOIS RD
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-7723
Practice Address - Country:US
Practice Address - Phone:636-717-6775
Practice Address - Fax:636-717-6755
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016014161207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology