Provider Demographics
NPI:1265674089
Name:HICKMAN, THOMAS TODD (DDS,PA)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:TODD
Last Name:HICKMAN
Suffix:
Gender:M
Credentials:DDS,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 S MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:CHESTERTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21620-1626
Mailing Address - Country:US
Mailing Address - Phone:410-778-1297
Mailing Address - Fax:410-778-3352
Practice Address - Street 1:202 S MAPLE AVE
Practice Address - Street 2:
Practice Address - City:CHESTERTOWN
Practice Address - State:MD
Practice Address - Zip Code:21620-1626
Practice Address - Country:US
Practice Address - Phone:410-778-1297
Practice Address - Fax:410-778-3552
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD110441223G0001X, 261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental