Provider Demographics
NPI:1922118389
Name:HICKMAN, EDWARD V (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:V
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 1:720 OAKRIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358
Mailing Address - Country:US
Mailing Address - Phone:910-738-8444
Mailing Address - Fax:910-671-8251
Practice Address - Street 1:720 OAKRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358
Practice Address - Country:US
Practice Address - Phone:910-738-8444
Practice Address - Fax:910-671-8251
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC53981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC93889OtherBC BS OF NC
NC8993889Medicaid
NC2428905Medicare ID - Type Unspecified
U38096Medicare UPIN