Provider Demographics
NPI:1467533133
Name:JOHN R LICKING DDS INC
Entity Type:Organization
Organization Name:JOHN R LICKING DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:LICKING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-736-6255
Mailing Address - Street 1:877 W FREMONT AVE
Mailing Address - Street 2:C3
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-2319
Mailing Address - Country:US
Mailing Address - Phone:408-736-6255
Mailing Address - Fax:408-736-6100
Practice Address - Street 1:877 W FREMONT AVE
Practice Address - Street 2:C3
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-2319
Practice Address - Country:US
Practice Address - Phone:408-736-6255
Practice Address - Fax:408-736-6100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty