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General NPI Number Information
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NPI Number | 1457331027
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Entity Type | Individual
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Provider Name | DAVID ALLEN VICKERS DMD
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Gender | Male
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Dates
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Enumeration Date | 01/19/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 908 MADISON AVE N
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City | DOUGLAS
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State | GA
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Zip | 31533-3126
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Country | US
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Telephone | 912-384-4902
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Fax | 912-384-8820
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Provider Business Mailing Address
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Address Line | 908 MADISON AVE N
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City | DOUGLAS
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State | GA
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Zip | 31533-3126
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Country | US
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Telephone | 912-384-4902
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Fax | 912-384-8820
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN010714
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License Number State | GA
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