Provider Demographics
NPI:1821214271
Name:DICKEY, JOHN W (DMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:DICKEY
Suffix:
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 1:201 MEDICAL ARTS DRIVE
Mailing Address - Street 2:
Mailing Address - City:SANDERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31082
Mailing Address - Country:US
Mailing Address - Phone:478-552-1230
Mailing Address - Fax:478-552-9948
Practice Address - Street 1:201 MEDICAL ARTS DRIVE
Practice Address - Street 2:
Practice Address - City:SANDERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31082
Practice Address - Country:US
Practice Address - Phone:478-552-1230
Practice Address - Fax:478-552-9948
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN009338122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist