Provider Demographics
NPI:1417056268
Name:HICKS, CHRISTIE GOLDA (RDH)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:GOLDA
Last Name:HICKS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13780 SW 51ST LN
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34481-8148
Mailing Address - Country:US
Mailing Address - Phone:352-237-7725
Mailing Address - Fax:
Practice Address - Street 1:120 N MONTGOMERY AVE
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34450-2439
Practice Address - Country:US
Practice Address - Phone:352-726-3641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH 17684124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist