Provider Demographics
NPI:1003992223
Name:DR DAVID G DICKERHOFF DDS & ASSOCIATES PA
Entity Type:Organization
Organization Name:DR DAVID G DICKERHOFF DDS & ASSOCIATES PA
Other - Org Name:SPRING LAKE DENTAL GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:CARR FINCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-497-3200
Mailing Address - Street 1:103 SUPERIOR DRIVE
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NC
Mailing Address - Zip Code:28390
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:103 SUPERIOR DRIVE
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:NC
Practice Address - Zip Code:28390
Practice Address - Country:US
Practice Address - Phone:910-497-3200
Practice Address - Fax:910-497-2209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
0137YOtherBLUE CROSS BLUE SHIELD
714367OtherUNITED CONCORDIA