Organization
HIXSON PEDIATRIC DENTISTRY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HUGH D VICE D.D.S.,M.S. (SENIOR PARTNER)
(423) 842-0165
Entity
Organization
Contact information
Practice address
5470 HIXSON PIKE STE A, HIXSON, TN 37343-3299
(423) 842-0165
(423) 842-7614
Mailing address
5470 HIXSON PIKE STE A, HIXSON, TN 37343-3299
(423) 842-0165
(423) 842-7614
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DS0000004055
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000338082B
—
GA
05
—
003126147A
—
GA
01
—
1033370853
PERSONAL NPI
—
05
—
1527928
—
TN
05
—
1528610
—
TN
05
—
1529061
—
TN
01
—
1548273212
PERSONAL NPI
—
01
—
1851382592
PERSONAL NPI
—
05
—
219618537A
—
GA
01
—
DN014567
DENTAL LICENSE
GA
01
—
DS0000004055
DENTAL LICENSE
TN
01
—
DS0000005135
DENTAL LICENSE
TN
01
—
DS0000009112
DENTAL LICENSE
TN
Enumeration date
09/23/2014
Last updated
09/23/2014
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