Provider Demographics
NPI:1336114644
Name:HICKEN, JOSEPH SHAUN (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:SHAUN
Last Name:HICKEN
Suffix:
Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:6601 LYNDALE AVE S
Mailing Address - Street 2:SUITE 240
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-2477
Mailing Address - Country:US
Mailing Address - Phone:612-869-8834
Mailing Address - Fax:612-638-1287
Practice Address - Street 1:6601 LYNDALE AVE S
Practice Address - Street 2:SUITE 240
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-2477
Practice Address - Country:US
Practice Address - Phone:612-869-8834
Practice Address - Fax:612-638-1287
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN113111223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics