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NPI Code Detail

MEDICARE: DR. MEGAN HICKMAN

MEDICARE: DR. MEGAN HICKMAN
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
11223G0001XGeneral Practice Dentistry7412NV

General Provider Information

NPI Number : 1861090722
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MEGAN HICKMAN
Provider Business Mailing Address
First Line : 366 W LAKE MEAD PKWY STE 100
Second Line :
City : HENDERSON
State : NV
Zip : 89015-7287
Country : US
Telephone Number : 702-464-3090
Fax Number :
Provider Business Practice Location Address
First Line : 366 W LAKE MEAD PKWY STE 100
Second Line :
City : HENDERSON
State : NV
Zip : 89015-7287
Country : US
Telephone Number : 702-464-3090
Fax Number : 702-464-3158
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2020
Last Update Date : 10/13/2020

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