MEDICARE: DR. THOMAS R DICKSON DDS

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	122300000X	Dentist	264648	UT

General Provider Information

NPI Number	:	1386779601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS R DICKSON DDS

Provider Business Mailing Address
First Line	:	714 FORT UNION BLVD
Second Line	:
City	:	MIDVALE
State	:	UT
Zip	:	84047-2347
Country	:	US
Telephone Number	:	801-567-0343
Fax Number	:	801-566-5725

Provider Business Practice Location Address
First Line	:	714 FORT UNION BLVD
Second Line	:
City	:	MIDVALE
State	:	UT
Zip	:	84047-2347
Country	:	US
Telephone Number	:	801-567-0343
Fax Number	:	801-566-5725

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

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	05/06/2024

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