Provider Demographics
NPI:1841061595
Name:HICKCOX, JINKY A (RDH, EPDH, DT, BSDH)
Entity type:Individual
Prefix:
First Name:JINKY
Middle Name:A
Last Name:HICKCOX
Suffix:
Gender:F
Credentials:RDH, EPDH, DT, BSDH
Other - Prefix:
Other - First Name:JINKY
Other - Middle Name:SANTOS
Other - Last Name:ACLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4925 SW GRIFFITH DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2923
Mailing Address - Country:US
Mailing Address - Phone:855-433-6825
Mailing Address - Fax:
Practice Address - Street 1:4925 SW GRIFFITH DR
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2923
Practice Address - Country:US
Practice Address - Phone:855-433-6825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDT0014125J00000X
ORH6784124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
No125J00000XDental ProvidersDental Therapist