Provider Demographics
NPI:1851479125
Name:DICKENS, JOSEPH MARION (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MARION
Last Name:DICKENS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 WEST PENNSYLVANIA AVENUE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204
Mailing Address - Country:US
Mailing Address - Phone:410-583-0800
Mailing Address - Fax:410-583-0802
Practice Address - Street 1:28 WEST PENNSYLVANIA AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204
Practice Address - Country:US
Practice Address - Phone:410-583-0800
Practice Address - Fax:410-583-0802
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD129731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice