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General NPI Number Information
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NPI Number | 1811013949
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Entity Type | Organization
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Legal Business Name | TERRY A HICKEY DDS PS
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 12/04/2012
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Provider Practice Location Address
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Address Line | 6919 LAKEWOOD DR W STE D4
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City | TACOMA
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State | WA
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Zip | 98467-3220
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Country | US
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Telephone | 253-475-8990
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Fax | 253-475-5514
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Provider Business Mailing Address
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Address Line | 6919 LAKEWOOD DR W STE D4
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City | TACOMA
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State | WA
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Zip | 98467-3220
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Country | US
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Telephone | 253-475-8990
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Fax | 253-475-5514
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Authorized Official
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Title or Position | OWNER
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Name | DR. TERRY ALLEN HICKEY
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Credential | DDS, PS
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Telephone | 253-475-8990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 5796
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License Number State | WA
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