Provider Demographics
NPI:1710073168
Name:DICKENS, STEVEN (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:
Last Name:DICKENS
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 BASNIGHT LN
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-2309
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2501 ATRIUM DR
Practice Address - Street 2:SUITE 301
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6452
Practice Address - Country:US
Practice Address - Phone:919-782-9560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC75981223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5904101Medicaid