Provider Demographics
NPI:1457472847
Name:DICKERSON, DAVID WOODROW (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WOODROW
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 1:2300 21ST AVE S
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-4927
Mailing Address - Country:US
Mailing Address - Phone:615-383-4747
Mailing Address - Fax:615-386-0494
Practice Address - Street 1:2300 21ST AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-4927
Practice Address - Country:US
Practice Address - Phone:615-383-4747
Practice Address - Fax:615-386-0494
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS 4152122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist