Provider Demographics
NPI:1194735365
Name:DIKEMAN, THERON L III (DDS)
Entity type:Individual
Prefix:DR
First Name:THERON
Middle Name:L
Last Name:DIKEMAN
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4399 OLD DOMINION DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207-3207
Mailing Address - Country:US
Mailing Address - Phone:703-525-2350
Mailing Address - Fax:703-528-2588
Practice Address - Street 1:4399 OLD DOMINION DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22207-3207
Practice Address - Country:US
Practice Address - Phone:703-525-2350
Practice Address - Fax:703-528-2588
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice