Provider Demographics
NPI:1285735803
Name:WICK, GEORGE PAXTON (DDS)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:PAXTON
Last Name:WICK
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 1:3805 N HIGH ST
Mailing Address - Street 2:STE 206
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214
Mailing Address - Country:US
Mailing Address - Phone:614-268-9443
Mailing Address - Fax:614-268-9447
Practice Address - Street 1:3805 N HIGH ST
Practice Address - Street 2:STE 206
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214
Practice Address - Country:US
Practice Address - Phone:614-268-9443
Practice Address - Fax:614-268-9447
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH174371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice