Provider Demographics
NPI:1720128705
Name:HICKEY, ALAN JOSEPH (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:JOSEPH
Last Name:HICKEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 CANCO RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-4351
Mailing Address - Country:US
Mailing Address - Phone:207-773-6711
Mailing Address - Fax:207-773-6552
Practice Address - Street 1:276 CANCO RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-4351
Practice Address - Country:US
Practice Address - Phone:207-773-6177
Practice Address - Fax:207-773-6552
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME26241223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MET31323Medicare UPIN