Provider Demographics
NPI:1851794978
Name:HICKIN, MATTHEW PARKER (DDS)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:PARKER
Last Name:HICKIN
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 1:73 HANCOCK ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-4107
Mailing Address - Country:US
Mailing Address - Phone:518-796-2942
Mailing Address - Fax:
Practice Address - Street 1:39 CROSS ST STE 307
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-1689
Practice Address - Country:US
Practice Address - Phone:978-717-5819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-02
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18569371223P0300X
NJ22DI025286001223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics