Provider Demographics
NPI:1477088383
Name:DICKINSON, DENNIS LEE
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:LEE
Last Name:DICKINSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 S MAIN ST STE 206
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-9391
Mailing Address - Country:US
Mailing Address - Phone:919-570-6556
Mailing Address - Fax:919-882-1141
Practice Address - Street 1:2006 S MAIN ST STE 206
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-9391
Practice Address - Country:US
Practice Address - Phone:919-570-6556
Practice Address - Fax:919-882-1141
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-28
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13799225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist