Provider Demographics
NPI:1932521176
Name:HICKMAN FAMILY DENTAL
Entity type:Organization
Organization Name:HICKMAN FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:S
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:515-276-4981
Mailing Address - Street 1:7117 HICKMAN RD
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-4851
Mailing Address - Country:US
Mailing Address - Phone:515-276-4981
Mailing Address - Fax:515-276-4864
Practice Address - Street 1:7117 HICKMAN RD
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-4851
Practice Address - Country:US
Practice Address - Phone:515-276-4981
Practice Address - Fax:515-276-4864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA07898122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty