Provider Demographics
NPI:1457440059
Name:BICKFORD, JOHN F (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:F
Last Name:BICKFORD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JACK
Other - Middle Name:F
Other - Last Name:BICKFORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:3036 ATLANTA HWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-5723
Mailing Address - Country:US
Mailing Address - Phone:770-445-6606
Mailing Address - Fax:770-443-1270
Practice Address - Street 1:3036 ATLANTA HWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-5723
Practice Address - Country:US
Practice Address - Phone:770-445-6606
Practice Address - Fax:770-443-1270
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA 87471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice