Individual provider Active NPI

James William Dickert Sr., D.M.D.

  • General Practice Dentistry
  • Greer, SC
National Provider Identifier
1861552630
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
SC2102 Issued in SC
Practice address
2104A Old Spartanburg Rd
Greer, SC 29650-2763
Phone
(864) 268-7812
Fax
(864) 268-6238
NPI assigned
Dec 11, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X SC2102 SC Primary

Addresses

Primary practice location

2104A Old Spartanburg Rd
Greer, SC 29650-2763

Mailing address

2104A Old Spartanburg Rd
Greer, SC 29650-2763
Phone (864) 268-7812

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140909001365 SC Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 1456570332

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
SC2102SCMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1861552630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2104A OLD SPARTANBURG RD",
            "city": "GREER",
            "state": "SC",
            "postal_code": "296502763",
            "telephone_number": "864-268-7812",
            "fax_number": "864-268-6238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2104A OLD SPARTANBURG RD",
            "city": "GREER",
            "state": "SC",
            "postal_code": "296502763",
            "telephone_number": "864-268-7812",
            "fax_number": "864-268-6238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKERT",
        "first_name": "JAMES",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "name_suffix": "Sr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "SC2102",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greer, SC

Sources for this page

Verify at the official NPI Registry.