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NPI Code Detail

MEDICARE: ANNA LOUISE HICKLIN DMD

MEDICARE: ANNA LOUISE HICKLIN DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist6907SC

General Provider Information

NPI Number : 1578875241
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNA LOUISE HICKLIN DMD
Provider Business Mailing Address
First Line : 210 LOIS ST
Second Line :
City : GREENVILLE
State : SC
Zip : 29601-2919
Country : US
Telephone Number : 803-468-2379
Fax Number :
Provider Business Practice Location Address
First Line : 415 FARRS BRIDGE RD
Second Line : ATTN: ANNA LOUISE HICKLIN, DMD
City : GREENVILLE
State : SC
Zip : 29617-1858
Country : US
Telephone Number : 864-246-2181
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/09/2010
Last Update Date : 05/14/2012

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Directions to “ ANNA LOUISE HICKLIN DMD” Practice Location

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