Provider Demographics
NPI:1477657526
Name:HICKS, ERIC V (DMD PC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:V
Last Name:HICKS
Suffix:
Gender:M
Credentials:DMD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 PARK STREET
Mailing Address - Street 2:
Mailing Address - City:EBENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15931-1854
Mailing Address - Country:US
Mailing Address - Phone:814-472-5270
Mailing Address - Fax:814-372-4618
Practice Address - Street 1:106 PARK STREET
Practice Address - Street 2:
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931-1854
Practice Address - Country:US
Practice Address - Phone:814-472-5270
Practice Address - Fax:814-372-4618
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS019589L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist