MEDICARE: DR. JOSEPH SHAUN HICKEN D.D.S., M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	11311	MN

General Provider Information

NPI Number	:	1336114644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH SHAUN HICKEN D.D.S., M.S.

Provider Business Mailing Address
First Line	:	6601 LYNDALE AVE S
Second Line	:	SUITE 240
City	:	RICHFIELD
State	:	MN
Zip	:	55423-2477
Country	:	US
Telephone Number	:	612-869-8834
Fax Number	:	612-638-1287

Provider Business Practice Location Address
First Line	:	6601 LYNDALE AVE S
Second Line	:	SUITE 240
City	:	RICHFIELD
State	:	MN
Zip	:	55423-2477
Country	:	US
Telephone Number	:	612-869-8834
Fax Number	:	612-638-1287

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	10/06/2011

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