Individual
JOHN L HICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1702 UNIVERSITY DR S, FARGO, ND 58103-4940
(701) 364-3300
(701) 364-8906
Mailing address
PO BOX 6001, FARGO, ND 58108-6001
(701) 364-3300
(701) 364-8906
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
1496
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
17823
—
ND
05
—
271817100
—
ND
05
—
40625
—
ND
01
—
4300108
MEDICA #
ND
01
—
6016
NDBS #
ND
01
—
61203HI
MNBS #
ND
01
—
676707
AMERICA'S PPO/ARAZ #
ND
01
—
6864
SIOUX VALLEY #
ND
01
—
8600254
MEDICA #
ND
01
—
DA9011026971
PREFERRED ONE #
ND
01
—
HP38190
HEALTHPARTNERS #
ND
01
—
ND200021
LHS #
ND
Enumeration date
07/11/2006
Last updated
08/17/2011
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