Provider Demographics
NPI:1609113174
Name:DICK, NANCY JEAN (DMD)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:JEAN
Last Name:DICK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3041 UNIVERSITY AVE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-3395
Mailing Address - Country:US
Mailing Address - Phone:304-599-8250
Mailing Address - Fax:304-599-6684
Practice Address - Street 1:3041 UNIVERSITY AVE
Practice Address - Street 2:SUITE #1
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3395
Practice Address - Country:US
Practice Address - Phone:304-599-8250
Practice Address - Fax:304-599-6684
Is Sole Proprietor?:No
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV27371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice