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General NPI Number Information
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NPI Number | 1407902893
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Entity Type | Individual
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Provider Name | KATHERINE VASILIKI HICKS DMD
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Gender | Female
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 01/29/2015
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Provider Practice Location Address
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Address Line | 630 ATLANTIC BLVD SUITE 7
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City | NEPTUNE BEACH
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State | FL
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Zip | 32266-4000
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Country | US
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Telephone | 904-247-2626
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Fax | 904-998-7702
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Provider Business Mailing Address
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Address Line | 3545-1 ST. JOHNS BLUFF RD. S. SUITE 352
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City | JACKSONVILLE
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State | FL
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Zip | 32224
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Country | US
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Telephone | 904-998-7000
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Fax | 904-998-7702
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN17174
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License Number State | FL
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