Provider Demographics
NPI:1841413093
Name:DALTON, MICHAEL EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:EDWARD
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 1:600 N COTNER BLVD
Mailing Address - Street 2:STE. 306
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-2343
Mailing Address - Country:US
Mailing Address - Phone:402-466-5602
Mailing Address - Fax:402-466-5637
Practice Address - Street 1:600 N COTNER BLVD
Practice Address - Street 2:STE. 306
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-2343
Practice Address - Country:US
Practice Address - Phone:402-466-5602
Practice Address - Fax:402-466-5637
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE47361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE5395OtherBLUE CROSS BLUE SHIELD
NE540275OtherUNITED CONCORDIA