Provider Demographics
NPI:1568482552
Name:DALTON, EDGAR R (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:R
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 1:700 PALMA SOLA BLVD
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-3340
Mailing Address - Country:US
Mailing Address - Phone:941-792-5520
Mailing Address - Fax:941-792-5520
Practice Address - Street 1:6302 MANATEE AVENUE EAST
Practice Address - Street 2:#B
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209
Practice Address - Country:US
Practice Address - Phone:941-792-2965
Practice Address - Fax:941-792-8955
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL42841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice