Individual
MRS. CECILIA JO HICKAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH-EA, OMT
Contact information
Practice address
1121 E. STATE STREET, SUITE - 102-D, EAGLE, ID 83616
(208) 584-9060
Mailing address
1121 E. STATE STREET, SUITE 102-D, EAGLE, ID 83616
(208) 584-9060
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
DH-0356-EA
ID
Other
Enumeration date
12/02/2014
Last updated
12/02/2014
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