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General NPI Number Information
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NPI Number | 1649440736
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Entity Type | Organization
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Legal Business Name | DICKSON DENTAL, PC
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Dates
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Enumeration Date | 03/05/2008
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Last Update Date | 03/05/2008
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Provider Practice Location Address
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Address Line | 5962 RICHMOND HWY
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City | ALEXANDRIA
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State | VA
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Zip | 22303-1871
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Country | US
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Telephone | 571-481-4410
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Fax | 571-481-4413
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Provider Business Mailing Address
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Address Line | 5962 RICHMOND HWY
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City | ALEXANDRIA
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State | VA
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Zip | 22303-1871
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Country | US
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Telephone | 571-481-4410
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Fax | 571-481-4413
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. STEPHANIE NICHOLS DICKSON
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Credential | D.M.D.
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Telephone | 571-481-4410
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401410681
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License Number State | VA
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