Provider Demographics
NPI:1215118286
Name:DICKES, WALTER HENRY (DDS)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:HENRY
Last Name:DICKES
Suffix:
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 1:47 PARK ST
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-1629
Mailing Address - Country:US
Mailing Address - Phone:207-667-5013
Mailing Address - Fax:207-667-4124
Practice Address - Street 1:47 PARK ST
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1629
Practice Address - Country:US
Practice Address - Phone:207-667-5013
Practice Address - Fax:207-667-4124
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME23301223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics