Provider Demographics
NPI:1760647911
Name:DICKERT, JAMES WILLIAM JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WILLIAM
Last Name:DICKERT
Suffix:JR
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 1:811 SAINT ANDREWS BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-2237
Mailing Address - Country:US
Mailing Address - Phone:843-571-7951
Mailing Address - Fax:
Practice Address - Street 1:811 SAINT ANDREWS BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-2237
Practice Address - Country:US
Practice Address - Phone:843-571-7951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-26
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC44581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice