MEDICARE: DR. BRENDA DICK 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	07622	IA
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	6438	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780699405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRENDA DICK DDS

Provider Business Mailing Address
First Line	:	4224 SERGEANT RD
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51106
Country	:	US
Telephone Number	:	712-276-2766
Fax Number	:	712-276-1707

Provider Business Practice Location Address
First Line	:	4224 SERGEANT RD
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51106
Country	:	US
Telephone Number	:	712-276-2766
Fax Number	:	712-276-1707

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

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. BRENDA DICK DDS” Practice Location

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