Provider Demographics
NPI:1922103274
Name:HICKS & HICKS PA
Entity Type:Organization
Organization Name:HICKS & HICKS PA
Other - Org Name:HICKS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SEC TREAS
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:K
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-325-6000
Mailing Address - Street 1:800 ZEAGLER DRIVE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177
Mailing Address - Country:US
Mailing Address - Phone:386-325-6000
Mailing Address - Fax:386-325-9306
Practice Address - Street 1:800 ZEAGLER DRIVE
Practice Address - Street 2:SUITE 330
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177
Practice Address - Country:US
Practice Address - Phone:386-325-6000
Practice Address - Fax:386-325-9306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00133681223G0001X
FLDN00135411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty