Doctor Name: | DR. MISTY IRENE DICKERSON |
NPI Number: | 1427296318 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | D.O. |
License Number: | 34.010654 |
Business Practice Address: | 7740 Washington Village Drive Suite 100 Centerville, OH - 454583994 |
Business Phone Number: | 9374334325 |
Business Fax Number: | |
Mailing Address: | 2912 Springboro Rd, Suite 201 MORAINE |
State: | OH |
Postal Code: | 454391674 |
Phone Number: | 9372978999 |
Fax Number: | |
NPI Enumeration Date: | 01/30/2009 |
NPI Last Update Date: | 08/27/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 34.010654 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |