Provider Demographics
NPI:1013993302
Name:FICK, HUSINE SAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:HUSINE
Middle Name:SAM
Last Name:FICK
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 1:3015 NAVARRE AVE
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-5303
Mailing Address - Country:US
Mailing Address - Phone:419-698-9784
Mailing Address - Fax:419-698-3304
Practice Address - Street 1:3015 NAVARRE AVE
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3398
Practice Address - Country:US
Practice Address - Phone:419-698-9784
Practice Address - Fax:419-698-3304
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH168271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice