Provider Demographics
NPI:1194732834
Name:HICKEY, KEVIN P (DDS)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:P
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 1:8108 CAZENOVIA ROAD
Mailing Address - Street 2:7 PINES OFFICE PARK BLDG 2
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104
Mailing Address - Country:US
Mailing Address - Phone:315-682-8921
Mailing Address - Fax:315-682-5561
Practice Address - Street 1:8108 CAZENOVIA ROAD
Practice Address - Street 2:7 PINES OFFICE PARK BLDG 2
Practice Address - City:MANLIUS
Practice Address - State:NY
Practice Address - Zip Code:13104
Practice Address - Country:US
Practice Address - Phone:315-682-8921
Practice Address - Fax:315-682-5561
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY341401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice