MEDICARE: DR. CHRISTOPHER DAVID DICKES D.D.S.

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	1223G0001X	General Practice Dentistry	D0519-30023	SD

General Provider Information

NPI Number	:	1619949112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER DAVID DICKES D.D.S.

Provider Business Mailing Address
First Line	:	109 DEW DROP IN LANE
Second Line	:
City	:	YANKTON
State	:	SD
Zip	:	57078
Country	:	US
Telephone Number	:	605-376-7256
Fax Number	:

Provider Business Practice Location Address
First Line	:	1412 WOOD ST
Second Line	:
City	:	SPRINGFIELD
State	:	SD
Zip	:	57062-2238
Country	:	US
Telephone Number	:	605-369-2201
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	02/05/2014

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