Healthcare Provider Details

I. General information

NPI: 1861552630
Provider Name (Legal Business Name): JAMES WILLIAM DICKERT SR. D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2104A OLD SPARTANBURG RD
GREER SC
29650-2763
US

IV. Provider business mailing address

2104A OLD SPARTANBURG RD
GREER SC
29650-2763
US

V. Phone/Fax

Practice location:
  • Phone: 864-268-7812
  • Fax: 864-268-6238
Mailing address:
  • Phone: 864-268-7812
  • Fax: 864-268-6238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberSC2102
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: