Individual
COREY DICKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3401 N BROAD ST, PHILADELPHIA, PA 19140-5189
(800) 836-7536
Mailing address
1431 FITZWATER ST UNIT 1, PHILADELPHIA, PA 19146-2290
(301) 821-0046
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DS044551
PA
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
03/16/2022
Last updated
05/15/2024
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