Provider Demographics
NPI:1700994126
Name:DALTON, FRANK T (DMD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:T
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 1:1407B N HARPER ROAD EXT
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-3749
Mailing Address - Country:US
Mailing Address - Phone:662-286-6904
Mailing Address - Fax:662-286-6905
Practice Address - Street 1:1407B N HARPER ROAD EXT
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-3749
Practice Address - Country:US
Practice Address - Phone:662-286-6904
Practice Address - Fax:662-286-6905
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2008-831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00060022Medicaid