Provider Demographics
NPI:1699921825
Name:CARL M HICKMAN DDS PA
Entity type:Organization
Organization Name:CARL M HICKMAN DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:M
Authorized Official - Last Name:HICKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-516-9919
Mailing Address - Street 1:15731 FM 2920
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77377
Mailing Address - Country:US
Mailing Address - Phone:281-516-9919
Mailing Address - Fax:281-516-1750
Practice Address - Street 1:15731 FM 2920
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77377
Practice Address - Country:US
Practice Address - Phone:281-516-9919
Practice Address - Fax:281-516-1750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD133461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty