Provider Demographics
NPI:1750098489
Name:DALTON DENTAL STUDIO, LLC
Entity type:Organization
Organization Name:DALTON DENTAL STUDIO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:DALTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-294-3703
Mailing Address - Street 1:100 BLUEGRASS COMMONS BLVD STE 2180
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-2738
Mailing Address - Country:US
Mailing Address - Phone:615-570-0003
Mailing Address - Fax:615-235-0061
Practice Address - Street 1:100 BLUEGRASS COMMONS BLVD STE 2180
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2738
Practice Address - Country:US
Practice Address - Phone:615-570-0003
Practice Address - Fax:615-235-0061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental