Provider Demographics
NPI:1073686937
Name:BICKNELL, CAROL M (DDS)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:M
Last Name:BICKNELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 1ST ST N
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING
Mailing Address - State:MN
Mailing Address - Zip Code:56320-1611
Mailing Address - Country:US
Mailing Address - Phone:320-685-8891
Mailing Address - Fax:320-685-5321
Practice Address - Street 1:311 1ST ST N
Practice Address - Street 2:
Practice Address - City:COLD SPRING
Practice Address - State:MN
Practice Address - Zip Code:56320-1611
Practice Address - Country:US
Practice Address - Phone:320-685-8891
Practice Address - Fax:320-685-5321
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN111381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice