Provider Demographics
NPI:1831434794
Name:HICKEY, TERRY ALLEN (DDS)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:ALLEN
Last Name:HICKEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6919 LAKEWOOD DR W
Mailing Address - Street 2:D-4
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98467-3220
Mailing Address - Country:US
Mailing Address - Phone:253-475-8990
Mailing Address - Fax:253-475-5514
Practice Address - Street 1:6919 LAKEWOOD DR W
Practice Address - Street 2:D-4
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98467-3220
Practice Address - Country:US
Practice Address - Phone:253-475-8990
Practice Address - Fax:253-475-5514
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA57961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice