Provider Demographics
NPI:1346412756
Name:DICKINSON, WILLIAM JEFFREY (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JEFFREY
Last Name:DICKINSON
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 1:1515 S OSPREY AVE
Mailing Address - Street 2:BLDG D
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2939
Mailing Address - Country:US
Mailing Address - Phone:941-955-5972
Mailing Address - Fax:941-955-8790
Practice Address - Street 1:1515 S OSPREY AVE
Practice Address - Street 2:BLDG D
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2939
Practice Address - Country:US
Practice Address - Phone:941-955-5972
Practice Address - Fax:941-955-8790
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL81441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice