Provider Demographics
NPI:1982851937
Name:DALTON, BRIAN ERIC (DMD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:ERIC
Last Name:DALTON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4435 E CHANDLER BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-7650
Mailing Address - Country:US
Mailing Address - Phone:480-753-1300
Mailing Address - Fax:480-753-1302
Practice Address - Street 1:4435 E CHANDLER BLVD STE 110
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-7650
Practice Address - Country:US
Practice Address - Phone:480-753-1300
Practice Address - Fax:480-753-1302
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD76451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice