Provider Demographics
NPI:1598789729
Name:HICKEY, TERENCE E (DMD)
Entity Type:Individual
Prefix:DR
First Name:TERENCE
Middle Name:E
Last Name:HICKEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1147 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2737
Mailing Address - Country:US
Mailing Address - Phone:203-755-5641
Mailing Address - Fax:203-755-1675
Practice Address - Street 1:1147 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2737
Practice Address - Country:US
Practice Address - Phone:203-755-5641
Practice Address - Fax:203-755-1675
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT55211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice