Provider Demographics
NPI:1023417417
Name:CHRIS DICKES DENTISTRY PROF LLC
Entity type:Organization
Organization Name:CHRIS DICKES DENTISTRY PROF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHRISTOPHER DICKES, D.D.S.
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:D
Authorized Official - Last Name:DICKES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-376-7256
Mailing Address - Street 1:1000 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-3730
Mailing Address - Country:US
Mailing Address - Phone:605-376-7256
Mailing Address - Fax:
Practice Address - Street 1:1000 W 4TH ST
Practice Address - Street 2:
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-3730
Practice Address - Country:US
Practice Address - Phone:605-376-7256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty