Provider Demographics
NPI:1982756755
Name:HICKS, SCOTT EDMUND (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:EDMUND
Last Name:HICKS
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 1:108 WHIPPLE ST
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1706
Mailing Address - Country:US
Mailing Address - Phone:928-445-6030
Mailing Address - Fax:928-445-6085
Practice Address - Street 1:108 WHIPPLE ST
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1706
Practice Address - Country:US
Practice Address - Phone:928-445-6030
Practice Address - Fax:928-445-6085
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ43741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice