Healthcare Provider Details

I. General information

NPI: 1487063145
Provider Name (Legal Business Name): DR. BRITTANY DICKINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2014
Last Update Date: 07/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 S CALIFORNIA AVE
CHICAGO IL
60608-2486
US

IV. Provider business mailing address

2001 S CALIFORNIA AVE
CHICAGO IL
60608-2486
US

V. Phone/Fax

Practice location:
  • Phone: 773-484-1201
  • Fax:
Mailing address:
  • Phone: 773-484-1201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019029985
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: