# RILEY J. HICKS D.D.S., P.A.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164615084
- **Authorized official:** DR. RILEY JARED HICKS D.D.S. (OWNER)
- **Authorized official phone:** (208) 528-6000

## Contact information

- **Practice address:** 3905 WASHINGTON PKWY, IDAHO FALLS, ID 83404-7596
- **Practice address phone:** (208) 528-6000
- **Practice address fax:** (208) 528-6399
- **Mailing address:** 3905 WASHINGTON PKWY, IDAHO FALLS, ID 83404-7596
- **Mailing address phone:** (208) 528-6000
- **Mailing address fax:** (208) 528-6399

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 3314 | ID | Yes |

## Other

- **Enumeration date:** 08/23/2007
- **Last updated:** 08/23/2007