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General NPI Number Information
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NPI Number | 1629351994
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Entity Type | Individual
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Provider Name | NANA DICKSON D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 09/23/2011
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Last Update Date | 02/01/2015
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Provider Practice Location Address
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Address Line | 3040 WILLIAMS DR STE. #201
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City | FAIRFAX
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State | VA
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Zip | 22031-4618
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Country | US
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Telephone | 571-419-6897
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Fax | 571-419-6889
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Provider Business Mailing Address
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Address Line | 3040 WILLIAMS DR STE. #201
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City | FAIRFAX
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State | VA
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Zip | 22031-4618
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Country | US
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Telephone | 571-419-6897
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Fax | 571-419-6889
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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 | 14996
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DEN1001083
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401414277
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License Number State | VA
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