Provider Demographics
NPI:1548393317
Name:DICKERSON, TODD EVAN (DDS MS PC)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:EVAN
Last Name:DICKERSON
Suffix:
Gender:M
Credentials:DDS MS PC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1200 W WARNER RD
Mailing Address - Street 2:STE 1
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224
Mailing Address - Country:US
Mailing Address - Phone:480-963-2535
Mailing Address - Fax:480-814-1334
Practice Address - Street 1:1200 W WARNER RD
Practice Address - Street 2:STE 1
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224
Practice Address - Country:US
Practice Address - Phone:480-963-2535
Practice Address - Fax:480-814-1334
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZD44231223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics