Provider Demographics
NPI:1952578403
Name:W. EDWARD DALTON, MD INC.
Entity Type:Organization
Organization Name:W. EDWARD DALTON, MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:W
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:DALTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-842-9732
Mailing Address - Street 1:3705 N.W. 63RD ST.
Mailing Address - Street 2:SUITE 204
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116
Mailing Address - Country:US
Mailing Address - Phone:405-842-9732
Mailing Address - Fax:405-842-9771
Practice Address - Street 1:3705 N.W. 63RD ST.
Practice Address - Street 2:SUITE 204
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116
Practice Address - Country:US
Practice Address - Phone:405-842-9732
Practice Address - Fax:405-842-9771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9436208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKE15954Medicare UPIN