Individual
DR. LELAND HICKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
809 W DETWEILLER DR, SUITE 805A, PEORIA, IL 61615-2149
(309) 692-1320
(309) 692-1355
Mailing address
9159 DEER RIDGE DR, BLOOMINGTON, IL 61704-7821
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1002205
—
IL
Enumeration date
02/01/2007
Last updated
07/08/2007
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