Provider Demographics
NPI:1306398706
Name:HICKEY, DONNA LEE (RDH)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:LEE
Last Name:HICKEY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:LEE
Other - Last Name:HICKEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDH
Mailing Address - Street 1:110 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-4904
Mailing Address - Country:US
Mailing Address - Phone:516-931-1747
Mailing Address - Fax:
Practice Address - Street 1:901 STEWART AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4893
Practice Address - Country:US
Practice Address - Phone:516-747-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019414-1124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist