Provider Demographics
NPI:1790912715
Name:DICKEY, DAVID GRAYSON
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GRAYSON
Last Name:DICKEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 BRYANT STREET
Mailing Address - Street 2:SUITE 2F
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107
Mailing Address - Country:US
Mailing Address - Phone:415-596-4168
Mailing Address - Fax:
Practice Address - Street 1:329 BRYANT ST
Practice Address - Street 2:SUITE 2F
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-1477
Practice Address - Country:US
Practice Address - Phone:415-596-4168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-17
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36914122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist