Healthcare Provider Details

I. General information

NPI: 1619163045
Provider Name (Legal Business Name): HICKMAN ORTHODONTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2007
Last Update Date: 09/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8001 SHELBY ST SUITE #1
INDIANAPOLIS IN
46227-5970
US

IV. Provider business mailing address

8001 SHELBY ST SUITE #1
INDIANAPOLIS IN
46227-5970
US

V. Phone/Fax

Practice location:
  • Phone: 317-888-7807
  • Fax: 317-888-0083
Mailing address:
  • Phone: 317-888-7807
  • Fax: 317-888-0083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. TODD ANDREW HICKMAN
Title or Position: OWNER/PRESIDENT
Credential: D.D.S. M.S.D.
Phone: 317-888-7807