Provider Demographics
NPI:1497835821
Name:HICKS, VINCENT E (DDS)
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:E
Last Name:HICKS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5111 MARYLAND WAY
Mailing Address - Street 2:SUITE 209
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027
Mailing Address - Country:US
Mailing Address - Phone:615-376-8865
Mailing Address - Fax:615-373-7699
Practice Address - Street 1:5111 MARYLAND WAY
Practice Address - Street 2:SUITE 209
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027
Practice Address - Country:US
Practice Address - Phone:615-376-8865
Practice Address - Fax:615-373-7699
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN71131223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics