Dickerson Enterprises, Incorporated

Primary specialty

DentistTaxonomy code 122300000X

License

D4940 Issued in AZ

Legal business name

DICKERSON ENTERPRISES, INCORPORATED

Practice address

6755 E Superstition Springs Blvd
Suite 203
Mesa, AZ 85206-4373

Phone

(480) 218-6030

Fax

(480) 218-6057

NPI assigned

Mar 9, 2007

Last updated

Mar 17, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Derrick J Dickerson, DMDNPI 1366531402

Title

President

Phone

(480) 218-6030

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Derrick J Dickerson, DMD

  • General Practice Dentistry
  • Mesa, AZ
  • NPI 1366531402
  NPD (past) Authorized official

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

{
    "created_epoch": "1173398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205712000000",
    "number": "1558493460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6755 E SUPERSTITION SPRINGS BLVD",
            "address_2": "SUITE 203",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852064373",
            "telephone_number": "480-218-6030",
            "fax_number": "480-218-6057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6755 E SUPERSTITION SPRINGS BLVD",
            "address_2": "SUITE 203",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852064373",
            "telephone_number": "480-218-6030",
            "fax_number": "480-218-6057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DICKERSON ENTERPRISES, INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-09",
        "last_updated": "2008-03-17",
        "status": "A",
        "authorized_official_last_name": "DICKERSON",
        "authorized_official_first_name": "DERRICK",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "480-218-6030",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "D4940",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cristina Diaz, CNM
• Monica Diaz, REGISTERED DIETICIAN
• Mikayla Dibelka
• Dibok, Inc (Aspen Optical)
• Brittany Dichraff, DPT
• Derrick J Dickerson, DMD
• John E Dickerson, DC
• Suzie Ann Dickey, APRN
• Kevin Michael Dicks, PHARM. D.
• Lisa Ann Dicks, PHARM.D.

• Dentist in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Dentist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2008; 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.