Provider Demographics
NPI:1316920044
Name:DICKSON, HILTON M (DMD)
Entity type:Individual
Prefix:
First Name:HILTON
Middle Name:M
Last Name:DICKSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:N MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-3024
Mailing Address - Country:US
Mailing Address - Phone:843-249-7736
Mailing Address - Fax:843-249-2349
Practice Address - Street 1:418 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-3024
Practice Address - Country:US
Practice Address - Phone:843-249-7736
Practice Address - Fax:843-249-2349
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice