Healthcare Provider Details

I. General information

NPI: 1982583365
Provider Name (Legal Business Name): DANIEL VINCENT HICKMAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2025
Last Update Date: 08/29/2025
Certification Date: 08/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2437 ENTERPRISE RD
ORANGE CITY FL
32763-7964
US

IV. Provider business mailing address

2951 DONCASTER DR
CHARLESTON SC
29414-6723
US

V. Phone/Fax

Practice location:
  • Phone: 386-774-8009
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN30974
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: