Provider Demographics
NPI:1689013872
Name:DICKENSON, BRENT M (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:M
Last Name:DICKENSON
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 1:2620 MINERAL SPRINGS AVENUE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917
Mailing Address - Country:US
Mailing Address - Phone:865-688-4442
Mailing Address - Fax:865-688-4503
Practice Address - Street 1:2620 MINERAL SPRINGS AVENUE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917
Practice Address - Country:US
Practice Address - Phone:865-688-4442
Practice Address - Fax:865-688-4503
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-20
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN96811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice