Provider Demographics
NPI:1982736815
Name:HICKE, BRUCE F (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:F
Last Name:HICKE
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 1:241 W 23RD ST
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91784-1345
Mailing Address - Country:US
Mailing Address - Phone:909-981-2288
Mailing Address - Fax:
Practice Address - Street 1:5182 MONTCLAIR PLAZA LN
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763
Practice Address - Country:US
Practice Address - Phone:909-626-3566
Practice Address - Fax:909-626-6112
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA220761223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery