Provider Demographics
NPI:1730490897
Name:HICKS, JOY LIOU (DMD)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:LIOU
Last Name:HICKS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4155 DARLEY AVE
Mailing Address - Street 2:UNIT C
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305-6536
Mailing Address - Country:US
Mailing Address - Phone:303-499-7072
Mailing Address - Fax:
Practice Address - Street 1:4155 DARLEY AVE
Practice Address - Street 2:UNIT C
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-6536
Practice Address - Country:US
Practice Address - Phone:303-499-7072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO103541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice