Healthcare Provider Details

I. General information

NPI: 1114975950
Provider Name (Legal Business Name): KENT FARR DICKSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 03/01/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 LONG PRAIRIE RD
FLOWER MOUND TX
75028
US

IV. Provider business mailing address

5000 LONG PRAIRIE RD
FLOWER MOUND TX
75028-2783
US

V. Phone/Fax

Practice location:
  • Phone: 972-420-1776
  • Fax: 972-436-6996
Mailing address:
  • Phone: 972-420-1776
  • Fax: 972-436-6996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberJ4085
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberJ4085
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: