Provider Demographics
NPI:1235227596
Name:HICKORY CREEK DENTAL ARTS, PC
Entity Type:Organization
Organization Name:HICKORY CREEK DENTAL ARTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:HAMBLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:931-668-4184
Mailing Address - Street 1:2681 S CHANCERY ST
Mailing Address - Street 2:
Mailing Address - City:MC MINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-3683
Mailing Address - Country:US
Mailing Address - Phone:931-668-4184
Mailing Address - Fax:931-668-4185
Practice Address - Street 1:2681 S CHANCERY ST
Practice Address - Street 2:
Practice Address - City:MC MINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-3683
Practice Address - Country:US
Practice Address - Phone:931-668-4184
Practice Address - Fax:931-668-4185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS20191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty