Healthcare Provider Details

I. General information

NPI: 1992544068
Provider Name (Legal Business Name): JENNIFER HICKS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N ESTRELLA PKWY STE B1
GOODYEAR AZ
85338-4136
US

IV. Provider business mailing address

744 E HAYWARD AVE
PHOENIX AZ
85020-4149
US

V. Phone/Fax

Practice location:
  • Phone: 623-882-0782
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD012134
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: