Healthcare Provider Details

I. General information

NPI: 1093979429
Provider Name (Legal Business Name): JESSICA DICKES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 04/29/2022
Certification Date: 04/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 4TH ST NW
WATERTOWN SD
57201-1558
US

IV. Provider business mailing address

PO BOX 5074
SIOUX FALLS SD
57117-5074
US

V. Phone/Fax

Practice location:
  • Phone: 605-886-8471
  • Fax: 605-886-9317
Mailing address:
  • Phone: 605-886-8471
  • Fax: 605-886-9317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number5918
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number8503
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: