Provider Demographics
NPI:1770646234
Name:HICKMAN, J. ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:J.
Middle Name:ROBERT
Last Name:HICKMAN
Suffix:
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 1:121 W KAGY BLVD
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-6000
Mailing Address - Country:US
Mailing Address - Phone:406-587-7200
Mailing Address - Fax:406-587-4621
Practice Address - Street 1:121 W KAGY BLVD
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6000
Practice Address - Country:US
Practice Address - Phone:406-587-7200
Practice Address - Fax:406-587-4621
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT12561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice