Provider Demographics
NPI:1336285113
Name:ERIC W HICKMAN DDS INC
Entity Type:Organization
Organization Name:ERIC W HICKMAN DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:HICKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:513-697-9772
Mailing Address - Street 1:3116 L MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:MAINEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45039
Mailing Address - Country:US
Mailing Address - Phone:513-697-9772
Mailing Address - Fax:513-697-0227
Practice Address - Street 1:3116 L MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:MAINEVILLE
Practice Address - State:OH
Practice Address - Zip Code:45039
Practice Address - Country:US
Practice Address - Phone:513-697-9772
Practice Address - Fax:513-697-0227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300202601223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty