Provider Demographics
NPI:1639374838
Name:HICKS, KATHERINE VALENTINE (DDS)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:VALENTINE
Last Name:HICKS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:VALENTINE
Other - Last Name:SHADEGG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:5200 E FARNESS DR.
Mailing Address - Street 2:SUITE # 102
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712
Mailing Address - Country:US
Mailing Address - Phone:520-323-3866
Mailing Address - Fax:520-372-2754
Practice Address - Street 1:5200 E FARNESS DR.
Practice Address - Street 2:SUITE # 102
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712
Practice Address - Country:US
Practice Address - Phone:520-323-3866
Practice Address - Fax:520-372-2754
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6705122300000X
AZ8840122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist