Provider Demographics
NPI:1942316732
Name:DICK, JAMES ALFRED (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ALFRED
Last Name:DICK
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 1:3501 EAST GORE BLVD.
Mailing Address - Street 2:APARTMENT #613
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501
Mailing Address - Country:US
Mailing Address - Phone:423-362-2646
Mailing Address - Fax:
Practice Address - Street 1:3501 E GORE BLVD
Practice Address - Street 2:APARTMENT #613
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-9813
Practice Address - Country:US
Practice Address - Phone:423-362-2646
Practice Address - Fax:423-877-9222
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS25411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice