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NPI Code Detail

MEDICARE: DR. PHILIP T DICKINSON D.D.S., M.S.

MEDICARE: DR. PHILIP T DICKINSON D.D.S., M.S.
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
11223X0400XOrthodontics and Dentofacial Orthopedics Dentistry382004026MI

General Provider Information

NPI Number : 1780840157
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PHILIP T DICKINSON D.D.S., M.S.
Provider Business Mailing Address
First Line : 1150 E SHERMAN BLVD STE 2700
Second Line :
City : MUSKEGON
State : MI
Zip : 49444-1886
Country : US
Telephone Number : 231-737-0001
Fax Number :
Provider Business Practice Location Address
First Line : 1150 E SHERMAN BLVD STE 2700
Second Line :
City : MUSKEGON
State : MI
Zip : 49444-1886
Country : US
Telephone Number : 231-737-0001
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/05/2008
Last Update Date : 08/05/2008

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