Provider Demographics
NPI:1033209150
Name:HICKAM, HAROLD EUGENE (DDS CERT OF ORTHODON)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:EUGENE
Last Name:HICKAM
Suffix:
Gender:M
Credentials:DDS CERT OF ORTHODON
Other - Prefix:
Other - First Name:HAROLD
Other - Middle Name:EUGENE
Other - Last Name:HICKAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS PC PROF CORPORAT
Mailing Address - Street 1:753 CARROLL STREET
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-3368
Mailing Address - Country:US
Mailing Address - Phone:478-987-6522
Mailing Address - Fax:770-234-5477
Practice Address - Street 1:753 CARROLL STREET
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-3368
Practice Address - Country:US
Practice Address - Phone:478-987-6522
Practice Address - Fax:770-234-5477
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8192122300000X
MO015639122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist