MEDICARE: HICKS ORTHODONTICS

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	D7653	TN

General Provider Information

NPI Number	:	1730266594
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HICKS ORTHODONTICS

Provider Business Mailing Address
First Line	:	11221 W POINT DR
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37934-2838
Country	:	US
Telephone Number	:	865-777-5700
Fax Number	:	865-777-5701

Provider Business Practice Location Address
First Line	:	11221 W POINT DRIVE
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37934-2838
Country	:	US
Telephone Number	:	865-777-5700
Fax Number	:	865-777-5701

Authorized Official
Title or Position	:	OWNER DOCTOR
Name	:	DR. JOSEPH DAVID HICKS
Credential	:	DDS MDS
Telephone Number	:	865-777-5700

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	06/25/2008

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Directions to “HICKS ORTHODONTICS ” Practice Location

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