Provider Demographics
NPI:1437521598
Name:NANA DICKSON, DDS PC
Entity Type:Organization
Organization Name:NANA DICKSON, DDS PC
Other - Org Name:ALLEGRA DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NANA
Authorized Official - Middle Name:ESI
Authorized Official - Last Name:DICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:571-419-6897
Mailing Address - Street 1:6251 CASDIN DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-2674
Mailing Address - Country:US
Mailing Address - Phone:503-803-8297
Mailing Address - Fax:571-419-6889
Practice Address - Street 1:3040 WILLIAMS DR
Practice Address - Street 2:SUITE #201
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4618
Practice Address - Country:US
Practice Address - Phone:571-419-6897
Practice Address - Fax:571-419-6889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-28
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401414277122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty