Provider Demographics
NPI:1427628114
Name:VICK, CAROLINE HINDS (DDS)
Entity type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:HINDS
Last Name:VICK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 S ULSTER ST APT 2021
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2870
Mailing Address - Country:US
Mailing Address - Phone:864-415-4654
Mailing Address - Fax:
Practice Address - Street 1:336 MAIN ST
Practice Address - Street 2:
Practice Address - City:WRAY
Practice Address - State:CO
Practice Address - Zip Code:80758-1707
Practice Address - Country:US
Practice Address - Phone:970-332-4817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002047781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice