Provider Demographics
NPI:1205671138
Name:WICKER, REANNA LEE (DDS)
Entity type:Individual
Prefix:
First Name:REANNA
Middle Name:LEE
Last Name:WICKER
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 1:6938 LAKE BLUFF CT
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-6023
Mailing Address - Country:US
Mailing Address - Phone:414-581-7120
Mailing Address - Fax:
Practice Address - Street 1:7315 CLINTON HWY STE A
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-5225
Practice Address - Country:US
Practice Address - Phone:865-938-6465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12567122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist