Individual
KENTON MICHAEL DICKISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4100 W 3RD ST, DAYTON, OH 45428-9000
(937) 268-6511
Mailing address
4100 W 3RD ST, DAYTON, OH 45428-9000
(937) 268-6511
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.006825RX
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
50.006825RX
—
OH
Enumeration date
01/16/2021
Last updated
04/15/2026
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