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General NPI Number Information
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NPI Number | 1851794978
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Entity Type | Individual
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Provider Name | MATTHEW PARKER HICKIN DDS
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Gender | Male
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Dates
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Enumeration Date | 10/02/2014
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Last Update Date | 03/14/2023
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Provider Practice Location Address
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Address Line | 39 CROSS ST STE 307
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City | PEABODY
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State | MA
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Zip | 01960-1689
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Country | US
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Telephone | 978-717-5819
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Fax |
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Provider Business Mailing Address
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Address Line | 73 HANCOCK ST APT 2
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City | BOSTON
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State | MA
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Zip | 02114-4107
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Country | US
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Telephone | 518-796-2942
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DN1856937
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 22DI02528600
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License Number State | NJ
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