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Individual
DR. MATTHEW TICICH
Active
Individual
DR. MATTHEW TICICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DEN.00203425
CO
1223E0200X
Endodontics
Primary
112743
CA
1223E0200X
Endodontics
11869
TN
1223E0200X
Endodontics
Primary
62475
CA
1223G0001X
General Practice Dentistry
31790
TX
1223G0001X
General Practice Dentistry
62475
CA
Other
Enumeration date
07/08/2013
Last updated
09/08/2026
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