Nathan Charlton Dickerson, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DD1601 Issued in NM

Practice address

2918 Hillrise Dr
Las Cruces, NM 88011-4702

Phone

(505) 522-0821

Fax

(505) 521-3556

NPI assigned

Apr 24, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1497974844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2918 HILLRISE DR",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880114702",
            "telephone_number": "505-522-0821",
            "fax_number": "505-521-3556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2918 HILLRISE DR",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880114702",
            "telephone_number": "505-522-0821",
            "fax_number": "505-521-3556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "NATHAN",
        "middle_name": "CHARLTON",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NM",
            "license": "DD1601",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Danielle Diaz, M.S., LMFT
• Mariah A Diaz, BT
• Tress Diaz
• Megan Dickens
• Isabella M Dickerson
• Taylor Layne Dickerson, PT
• Amber Carrie Diego, MA., CCC-SLP
• Carrie Alissa Dieker, M.D.
• Digestive Disease Consultants of Las Cruces LLC
• Timothy T Dillen

• Oral and Maxillofacial Surgery (Dentist) in Las Cruces, NM
• Providers in Las Cruces, NM by specialty
• Oral and Maxillofacial Surgery (Dentist) in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.