Provider Demographics
NPI:1982734471
Name:DALTON, BENNIE CLARK (DMD MS)
Entity Type:Individual
Prefix:DR
First Name:BENNIE
Middle Name:CLARK
Last Name:DALTON
Suffix:
Gender:M
Credentials:DMD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1203 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-1620
Mailing Address - Country:US
Mailing Address - Phone:843-342-3636
Mailing Address - Fax:843-342-9294
Practice Address - Street 1:1203 MAIN STREET
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-1620
Practice Address - Country:US
Practice Address - Phone:843-342-3636
Practice Address - Fax:843-342-9294
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4831223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics