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General NPI Number Information
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NPI Number | 1649646191
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Entity Type | Organization
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Legal Business Name | RONALD ANDREW DICKENS, D.D.S., INC
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Dates
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Enumeration Date | 08/19/2015
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Last Update Date | 08/19/2015
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Provider Practice Location Address
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Address Line | 38924 COAL RIVER RD
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City | WHITESVILLE
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State | WV
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Zip | 25209
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Country | US
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Telephone | 304-854-2110
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Fax |
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Provider Business Mailing Address
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Address Line | 38924 COAL RIVER RD
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City | WHITESVILLE
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State | WV
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Zip | 25209
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Country | US
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Telephone | 304-854-2110
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RONALD ANDREW DICKENS
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Credential | DDS
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Telephone | 304-252-6422
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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 | 3371
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License Number State | WV
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