Provider Demographics
NPI:1619949112
Name:DICKES, CHRISTOPHER DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:DAVID
Last Name:DICKES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:CHRIS
Other - Middle Name:DAVID
Other - Last Name:DICKES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:109 DEW DROP IN LANE
Mailing Address - Street 2:
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078
Mailing Address - Country:US
Mailing Address - Phone:605-376-7256
Mailing Address - Fax:
Practice Address - Street 1:1412 WOOD ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:SD
Practice Address - Zip Code:57062-2238
Practice Address - Country:US
Practice Address - Phone:605-369-2201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD0519-300231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice