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General NPI Number Information
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NPI Number | 1932747581
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Entity Type | Organization
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Legal Business Name | HICKS DENTAL CLINICS LLC
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Dates
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Enumeration Date | 12/13/2019
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Last Update Date | 12/13/2019
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Provider Practice Location Address
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Address Line | 905 SW RIMROCK WAY STE 201
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City | REDMOND
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State | OR
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Zip | 97756-2569
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Country | US
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Telephone | 541-526-5661
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Fax |
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Provider Business Mailing Address
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Address Line | 66855 FRYREAR RD
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City | BEND
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State | OR
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Zip | 97703-9193
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Country | US
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Telephone | 865-335-4571
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/DENTIST
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Name | DENISE GAYLE HICKS
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Credential | DDS
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Telephone | 865-335-4571
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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