Provider Demographics
NPI:1336401546
Name:HAROLD E. HICKAM, DDS, PC
Entity Type:Organization
Organization Name:HAROLD E. HICKAM, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:HICKAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:478-987-6522
Mailing Address - Street 1:753 CARROLL ST
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-3368
Mailing Address - Country:US
Mailing Address - Phone:478-987-6522
Mailing Address - Fax:770-234-5477
Practice Address - Street 1:753 CARROLL ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-3368
Practice Address - Country:US
Practice Address - Phone:478-987-6522
Practice Address - Fax:770-234-5477
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAROLD E. HICKAM, DDS, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0081921223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty