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Individual
D ALTON FANNING JR.
Active
Individual
D ALTON FANNING JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
SC3162
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
783979
UNITED CONCORDIA
—
05
—
ZA9748
—
SC
Enumeration date
08/04/2006
Last updated
07/08/2007
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