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General NPI Number Information
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NPI Number | 1780119867
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Entity Type | Individual
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Provider Name | JUSTIN DENHART DICKSON DO
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Gender | Male
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Dates
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Enumeration Date | 04/26/2017
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 4881 SUGAR MAPLE DR
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City | WRIGHT PATTERSON AFB
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State | OH
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Zip | 45433-5529
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Country | US
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Telephone | 937-257-0387
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Fax |
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Provider Business Mailing Address
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Address Line | 9201 W THOMAS RD
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City | PHOENIX
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State | AZ
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Zip | 85037-3332
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Country | US
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Telephone | 623-327-4000
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Fax |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 011468
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 34.013591
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License Number State | OH
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