Michael Shumway Dickerson, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D008558 Issued in AZ

Practice address

2233 W Baseline Rd
Suite 104
Tempe, AZ 85283-1039

Phone

(602) 438-9245

Fax

(602) 438-8695

NPI assigned

Aug 28, 2012

Sex

Male

Sole proprietor

No

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

Practice roles

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.

• Gregory L. Ten Eyck DDS PC

  • General Practice Dentistry
  • Tempe, AZ
  • NPI 1023221405
  NPD (past)
• South Mountain Dental LLC

  • General Practice Dentistry
  • Tempe, AZ
  • NPI 1821751777
  NPD (past)

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

{
    "created_epoch": "1346112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487721600000",
    "number": "1619225307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2233 W BASELINE RD",
            "address_2": "SUITE 104",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852831039",
            "telephone_number": "602-438-9245",
            "fax_number": "602-438-8695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2233 W BASELINE RD",
            "address_2": "SUITE 104",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852831039",
            "telephone_number": "602-438-9245",
            "fax_number": "602-438-8695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "MICHAEL",
        "middle_name": "SHUMWAY",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-08-28",
        "last_updated": "2017-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D008558",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paul Diamond, D.M.D.
• Marcia Diane, LPC, LISAC
• Maria Diaz-Arellano
• Francisca Diaz, WHNP
• Andrew Forbes Dickens, NMD
• Katherine Marie Dickinson, RNFA
• Rachel Dickman, RBT
• Beth Dickson, OTR/L
• Marcus Dickson
• Mary Didde-Esteban

• General Practice Dentistry in Tempe, AZ
• Providers in Tempe, AZ by specialty
• General Practice Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2017; 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.