Basic Information
| Provider Information | |||||||||
| NPI: | 1194746727 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DYKES | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | ALBERT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | D.D.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1201 BUFFALO ST | ||||||||
| Address2: | APT #4 | ||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376046772 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237940549 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | VA MEDICAL CENTER | ||||||||
| Address2: | PO 4000 | ||||||||
| City: | MOUNTAIN HOME | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37684 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239261171 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | D.S. 1915 | TN | Y | Dental Providers | Dentist | General Practice |
No ID Information.