Provider Demographics
NPI:1184076051
Name:BRICKER, HALIE MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:HALIE
Middle Name:MARIE
Last Name:BRICKER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2509 CEDAR COVE RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68507-1213
Mailing Address - Country:US
Mailing Address - Phone:308-440-4093
Mailing Address - Fax:
Practice Address - Street 1:1212 DUFF AVE
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-5467
Practice Address - Country:US
Practice Address - Phone:515-233-2174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA093191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice