Provider Demographics
NPI:1720254295
Name:ERIC V. HICKS, DMD, PC
Entity Type:Organization
Organization Name:ERIC V. HICKS, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:V
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:814-472-5270
Mailing Address - Street 1:106 PARK ST
Mailing Address - Street 2:
Mailing Address - City:EBENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15931-1854
Mailing Address - Country:US
Mailing Address - Phone:814-472-5270
Mailing Address - Fax:814-472-4618
Practice Address - Street 1:106 PARK ST
Practice Address - Street 2:
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931-1854
Practice Address - Country:US
Practice Address - Phone:814-472-5270
Practice Address - Fax:814-472-4618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS019589L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty