Provider Demographics
NPI:1376503508
Name:HICKSON, HARRY T (DMD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:T
Last Name:HICKSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 EISENHOWER DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-3905
Mailing Address - Country:US
Mailing Address - Phone:912-356-2139
Mailing Address - Fax:912-351-6302
Practice Address - Street 1:2011 EISENHOWER DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3905
Practice Address - Country:US
Practice Address - Phone:912-356-2139
Practice Address - Fax:912-351-6302
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0084231223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health