Healthcare Provider Details

I. General information

NPI: 1144155367
Provider Name (Legal Business Name): MEOSHI HICKS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 E AVE
CARRIZOZO NM
88301-8154
US

IV. Provider business mailing address

710 E AVE
CARRIZOZO NM
88301-8154
US

V. Phone/Fax

Practice location:
  • Phone: 575-648-2839
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDB-2026-0212
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: