Individual
DR. ANDREW EVERETT WICKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
131 INDIAN LAKE BLVD STE 100, HENDERSONVILLE, TN 37075-6207
(615) 822-8403
(615) 537-7696
Mailing address
131 INDIAN LAKE BLVD STE 100, HENDERSONVILLE, TN 37075-6207
(615) 822-8403
(615) 537-7696
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
9682
TN
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
9682
TN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/28/2013
Last updated
06/16/2018
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