Individual
DAVID MARK HICKLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
10 RICHLAND MEDICAL PARK DR STE A, COLUMBIA, SC 29203-6892
(803) 434-6565
(803) 434-6299
Mailing address
PO BOX 743904, ATLANTA, GA 30374-3904
(803) 434-6565
(803) 434-4629
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4261
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZX4261
—
SC
Enumeration date
03/12/2007
Last updated
10/12/2018
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