MEDICARE: HILTON M DICKSON D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	1925	SC

General Provider Information

NPI Number	:	1316920044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HILTON M DICKSON D.M.D.

Provider Business Mailing Address
First Line	:	418 MAIN ST
Second Line	:
City	:	N MYRTLE BEACH
State	:	SC
Zip	:	29582-3024
Country	:	US
Telephone Number	:	843-249-7736
Fax Number	:	843-249-2349

Provider Business Practice Location Address
First Line	:	418 MAIN ST
Second Line	:
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-3024
Country	:	US
Telephone Number	:	843-249-7736
Fax Number	:	843-249-2349

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2005
Last Update Date	:	07/08/2007

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