Provider Demographics
NPI:1336597558
Name:DICKINSON, DONALD REED III (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:REED
Last Name:DICKINSON
Suffix:III
Gender:M
Credentials:DDS, MD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:601 E YORBA LINDA BLVD
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-3006
Mailing Address - Country:US
Mailing Address - Phone:714-376-1876
Mailing Address - Fax:
Practice Address - Street 1:1100 S MOUNT VERNON AVE
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-4255
Practice Address - Country:US
Practice Address - Phone:909-801-8144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-27
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100209204E00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery