Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 9675 | CO |
N | 204E00000X | Oral & Maxillofacial Surgeon | 2403 | OH |
NPI | 1528261682 |
---|---|
Provider Name | Dale L Alto |
First Address | Colorado Springs, CO 80916 |
Second Address | Colorado Springs, CO 80917-5321 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2007 |
Last Update Date | 14/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
34054022 | (05) | CO |