MEDICARE: DR. AARON JAMES WICKS DDS

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	1223G0001X	General Practice Dentistry	050804	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790978971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AARON JAMES WICKS DDS

Provider Business Mailing Address
First Line	:	2474 8TH AVE STE A
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10027-7710
Country	:	US
Telephone Number	:	212-234-6088
Fax Number	:	212-234-6088

Provider Business Practice Location Address
First Line	:	2474 8TH AVE STE A
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10027-7710
Country	:	US
Telephone Number	:	212-234-6088
Fax Number	:	212-234-6088

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

Provider Enumeration Date	:	08/22/2007
Last Update Date	:	08/22/2007

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