MEDICARE: DEVIN DICKINSON DDS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DE60372263	WA

General Provider Information

NPI Number	:	1356758320
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEVIN DICKINSON DDS PLLC

Provider Business Mailing Address
First Line	:	302 E DIVISION ST
Second Line	:
City	:	ARLINGTON
State	:	WA
Zip	:	98223-1292
Country	:	US
Telephone Number	:	360-435-3661
Fax Number	:

Provider Business Practice Location Address
First Line	:	302 E DIVISION ST
Second Line	:
City	:	ARLINGTON
State	:	WA
Zip	:	98223-1292
Country	:	US
Telephone Number	:	360-435-3661
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. DEVIN JAMES DICKINSON
Credential	:	DDS
Telephone Number	:	360-435-3661

Provider Enumeration Date	:	07/22/2014
Last Update Date	:	07/22/2014

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