Active NPI
David Gary Dickerhoff, DDS
- Dentist
- Spring Lake, NC
National Provider Identifier
1053405019
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 6333
- Practice address
- 103 Superior Drive
Spring Lake, NC 28390 - Phone
- (910) 497-3200
- Fax
- (910) 497-2209
- NPI assigned
- Oct 3, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 6333 | NC | Primary |
Addresses
Primary practice location
103 Superior Drive
Spring Lake, NC 28390
Mailing address
875 Seagull Drive
Vass, NC 28394
Phone (910) 245-1414
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 854019 | Other | UNITED CONCORDIA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150420001536 | NC | Order and Referring Only - Oral Surgery | 3577881762 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6333 | NC | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dr David G Dickerhoff DDS & Associates PA | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dental Clinic/Center
- Spring Lake, NC
- NPI 1003992223
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1053405019",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "875 SEAGULL DRIVE",
"city": "VASS",
"state": "NC",
"postal_code": "28394",
"telephone_number": "910-245-1414"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "103 SUPERIOR DRIVE",
"city": "SPRING LAKE",
"state": "NC",
"postal_code": "28390",
"telephone_number": "910-497-3200",
"fax_number": "910-497-2209"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DICKERHOFF",
"first_name": "DAVID",
"middle_name": "GARY",
"name_prefix": "Mr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-03",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NC",
"license": "6333",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA",
"identifier": "854019",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Spring Lake, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.