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General NPI Number Information
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NPI Number | 1730506924
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Entity Type | Individual
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Provider Name | ANDREA HICKSON-MOORE RDH
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Gender | Female
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Dates
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Enumeration Date | 03/25/2014
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Last Update Date | 03/25/2014
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Provider Practice Location Address
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Address Line | 361 MAPLE ST 9B
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City | BROOKLYN
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State | NY
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Zip | 11225-5134
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Country | US
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Telephone | 347-787-2259
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Fax |
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Provider Business Mailing Address
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Address Line | 361 MAPLE ST 9B
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City | BROOKLYN
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State | NY
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Zip | 11225-5134
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Country | US
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Telephone | 347-787-2259
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Fax |
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 024517
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 001958
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License Number State | NY
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