Provider Demographics
NPI:1912200031
Name:HICKORY, JOHN E (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:E
Last Name:HICKORY
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 1:412 ANN ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-4662
Mailing Address - Country:US
Mailing Address - Phone:910-763-8163
Mailing Address - Fax:910-763-4505
Practice Address - Street 1:412 ANN ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-4662
Practice Address - Country:US
Practice Address - Phone:910-763-8163
Practice Address - Fax:910-763-4505
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-11
Last Update Date:2010-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA066331223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery