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General NPI Number Information
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NPI Number | 1336401546
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Entity Type | Organization
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Legal Business Name | HAROLD E. HICKAM, DDS, PC
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Dates
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Enumeration Date | 06/13/2012
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Last Update Date | 06/13/2012
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Provider Practice Location Address
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Address Line | 753 CARROLL ST
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City | PERRY
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State | GA
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Zip | 31069-3368
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Country | US
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Telephone | 478-987-6522
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Fax | 770-234-5477
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Provider Business Mailing Address
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Address Line | 753 CARROLL ST
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City | PERRY
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State | GA
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Zip | 31069-3368
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Country | US
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Telephone | 478-987-6522
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Fax | 770-234-5477
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. HAROLD EUGENE HICKAM
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Credential | DDS
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Telephone | 478-987-6522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN008192
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License Number State | GA
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