Provider Demographics
NPI:1689792905
Name:DICKSON, THOMAS MILTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MILTON
Last Name:DICKSON
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 1:509 E ELM ST
Mailing Address - Street 2:P.O. BOX 596
Mailing Address - City:GAINESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76240-4132
Mailing Address - Country:US
Mailing Address - Phone:940-665-2834
Mailing Address - Fax:940-665-2941
Practice Address - Street 1:509 E ELM ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240-4132
Practice Address - Country:US
Practice Address - Phone:940-665-2834
Practice Address - Fax:940-665-2941
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6659122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist