Provider Demographics
NPI:1770207573
Name:HICKS, CHELSEY NICOLE (DDS)
Entity type:Individual
Prefix:
First Name:CHELSEY
Middle Name:NICOLE
Last Name:HICKS
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 1:15 LONGMONT CT
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-2448
Mailing Address - Country:US
Mailing Address - Phone:804-305-5838
Mailing Address - Fax:
Practice Address - Street 1:2 GREENMEADOW DR
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-3230
Practice Address - Country:US
Practice Address - Phone:410-252-2424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17600122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty