Healthcare Provider Details

I. General information

NPI: 1619949112
Provider Name (Legal Business Name): CHRISTOPHER DAVID DICKES D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CHRIS DAVID DICKES D.D.S.

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 02/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1412 WOOD ST
SPRINGFIELD SD
57062-2238
US

IV. Provider business mailing address

109 DEW DROP IN LANE
YANKTON SD
57078
US

V. Phone/Fax

Practice location:
  • Phone: 605-369-2201
  • Fax:
Mailing address:
  • Phone: 605-376-7256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD0519-30023
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: