Provider Demographics
NPI:1710176805
Name:DICKINSON & WELLS PLLC
Entity Type:Organization
Organization Name:DICKINSON & WELLS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:903-645-2044
Mailing Address - Street 1:PO BOX 586
Mailing Address - Street 2:
Mailing Address - City:DAINGERFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:75638-0586
Mailing Address - Country:US
Mailing Address - Phone:903-645-2044
Mailing Address - Fax:903-645-2270
Practice Address - Street 1:213 SCURRY STREET
Practice Address - Street 2:A
Practice Address - City:DAINGERFIELD
Practice Address - State:TX
Practice Address - Zip Code:75638-1658
Practice Address - Country:US
Practice Address - Phone:903-645-2044
Practice Address - Fax:903-645-2270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00237363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154923001Medicaid
TX154923002Medicaid
TX154923001Medicaid