Individual
DR. PHILLIP DANA VICKERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
200 1ST ST SW, ROCHESTER, MN 55905-0001
(507) 284-2511
Mailing address
200 1ST ST SW, ROCHESTER, MN 55905-0001
(507) 284-2511
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
D10753
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
128G2VI
BLUE CROSS
MN
05
—
209324300
—
MN
Enumeration date
12/13/2006
Last updated
01/16/2024
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