Provider Demographics
NPI:1972172542
Name:HICKS, KIRSTEN EMORY (DMD)
Entity Type:Individual
Prefix:DR
First Name:KIRSTEN
Middle Name:EMORY
Last Name:HICKS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 DELLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-5013
Mailing Address - Country:US
Mailing Address - Phone:864-567-8876
Mailing Address - Fax:
Practice Address - Street 1:1412 PELHAM RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3921
Practice Address - Country:US
Practice Address - Phone:864-234-7023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-18
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDGD9949GD122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist