Individual
MICAH DICKERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3925 MINNESOTA AVE NE, WASHINGTON, DC 20019-2662
(312) 274-4530
Mailing address
1270 4TH ST NE APT 404, WASHINGTON, DC 20002-5894
(901) 220-4845
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0401419305
VA
122300000X
Dentist
DEN2000422
DC
1223P0221X
Pediatric Dentistry
Primary
0401419305
VA
1223P0221X
Pediatric Dentistry
18946
MD
1223P0221X
Pediatric Dentistry
DEN2000422
DC
Other
Enumeration date
11/20/2023
Last updated
08/12/2026
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