Provider Demographics
NPI:1508982539
Name:HICKS, PAUL PRESTON JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:PRESTON
Last Name:HICKS
Suffix:JR
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:PO BOX 401
Mailing Address - Street 2:1707 EAST THIRD STREET
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-0401
Mailing Address - Country:US
Mailing Address - Phone:434-392-8185
Mailing Address - Fax:434-392-8186
Practice Address - Street 1:1707 EAST THIRD STREET
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-0401
Practice Address - Country:US
Practice Address - Phone:434-392-8185
Practice Address - Fax:434-392-8186
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010042461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice