Provider Demographics
NPI:1093939811
Name:DONALD E. HICKS,D.D.S.,P.C.
Entity Type:Organization
Organization Name:DONALD E. HICKS,D.D.S.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:660-826-8844
Mailing Address - Street 1:710 S LIMIT AVE
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-3951
Mailing Address - Country:US
Mailing Address - Phone:660-826-8844
Mailing Address - Fax:
Practice Address - Street 1:710 S LIMIT AVE
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-3951
Practice Address - Country:US
Practice Address - Phone:660-826-8844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0136911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty