Provider Demographics
NPI:1497971659
Name:PICKLESIMER, JOHN D (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:PICKLESIMER
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 1:4713 COLLEGE ACRES DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-1725
Mailing Address - Country:US
Mailing Address - Phone:910-799-2238
Mailing Address - Fax:910-392-3414
Practice Address - Street 1:4713 COLLEGE ACRES DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-1725
Practice Address - Country:US
Practice Address - Phone:910-799-2238
Practice Address - Fax:910-392-3414
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC37081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice