MEDICARE: CHRIS DICKES FAMILY DENTISTRY, PROF. LLC

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	SD

General Provider Information

NPI Number	:	1700259496
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRIS DICKES FAMILY DENTISTRY, PROF. LLC

Provider Business Mailing Address
First Line	:	1000 W 4TH ST
Second Line	:	SUITE 2
City	:	YANKTON
State	:	SD
Zip	:	57078-3700
Country	:	US
Telephone Number	:	605-660-8409
Fax Number	:	605-665-4584

Provider Business Practice Location Address
First Line	:	1704 S CLEVELAND AVE
Second Line	:	SUITE 4
City	:	SIOUX FALLS
State	:	SD
Zip	:	57103-3903
Country	:	US
Telephone Number	:	605-660-8409
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. CHRISTOPHER D DICKES
Credential	:	DDS
Telephone Number	:	605-376-7256

Provider Enumeration Date	:	11/04/2015
Last Update Date	:	11/04/2015

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