Provider Demographics
NPI:1629398425
Name:DICKSON, JONATHAN MUNGER (DMD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:MUNGER
Last Name:DICKSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 N WHITMAN WAY
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2192
Mailing Address - Country:US
Mailing Address - Phone:509-888-8088
Mailing Address - Fax:
Practice Address - Street 1:211 N WHITMAN WAY
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2192
Practice Address - Country:US
Practice Address - Phone:509-888-8088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60292621122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist