Provider Demographics
NPI:1023360617
Name:DICKERSON, JOHN DEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DEE
Last Name:DICKERSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2060 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-4312
Mailing Address - Country:US
Mailing Address - Phone:614-486-7782
Mailing Address - Fax:
Practice Address - Street 1:2060 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-4312
Practice Address - Country:US
Practice Address - Phone:614-486-7782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH126601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice