Provider Demographics
NPI:1578051884
Name:HICKS, ARLISHA BULLARD (DDS)
Entity Type:Individual
Prefix:MRS
First Name:ARLISHA
Middle Name:BULLARD
Last Name:HICKS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MS
Other - First Name:ARLISHA
Other - Middle Name:JASMINE
Other - Last Name:BULLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10001 OXFORDSHIRE AVE APT 64119
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76131-2334
Mailing Address - Country:US
Mailing Address - Phone:832-876-9713
Mailing Address - Fax:
Practice Address - Street 1:10001 OXFORDSHIRE AVE APT 64119
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76131-2334
Practice Address - Country:US
Practice Address - Phone:832-876-9713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-23
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX372581223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program